The Financial Supervisory Service set up a system to regularly share data on indemnity and health insurance with the National Health Insurance Service under the Ministry of Health and Welfare. Currently, the FSS holds data related to claims for noncovered treatment costs under indemnity insurance, while the Ministry of Health and Welfare and the National Health Insurance Service each hold data related to covered benefits under the national health insurance.
Until now, the two institutions did not share the data they held, which limited investigations into fraudulent insurance payouts. In response, the two sides agreed to share relevant information and respond quickly when numerous suspected cases of fraudulent insurance payouts arise related to a particular matter.
According to financial authorities on the 3rd, the FSS and the National Health Insurance Service recently concluded consultations on a plan to jointly review data they each hold when organized or large-scale fraudulent insurance payouts are suspected. For example, when the FSS receives a tip from an insurer about suspected fraudulent payouts related to noncovered indemnity claims, it will review information from the National Health Insurance Service—such as the patient's actual number of hospitalization days—that is difficult for the FSS to verify on its own.
Through a business agreement in Jun., the FSS and the National Health Insurance Service pushed measures to curb excessive expansion of noncovered items by sharing health insurance and indemnity information held by each institution and cooperating in operations. At the time, always-on data sharing via computer systems was also discussed, but considering the sensitivity of personal information, they decided to share only the necessary data directly.
The FSS and the Ministry of Health and Welfare moved to cooperate on data sharing after signs emerged recently that many long-term care hospitals were illegally offering so-called "paybacks," returning a certain percentage of treatment costs collected from patients. At that time, the FSS shared key information, including the status of indemnity insurance claims for noncovered treatments by inpatients at long-term care hospitals under investigation by the Ministry of Health and Welfare. With this cooperation, the FSS and the National Health Insurance Service decided to establish an ongoing information-sharing system on specific themes.
An FSS official said, "We are currently sharing necessary information upon mutual request and plan to continue the cooperation framework."