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KMID : 1234820130140020011
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Korean Society of Law and Medicine
2013 Volume.14 No. 2 p.11 ~ p.41
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Legal Issues on Deception of Fraud and Abuse of Paid Medical Expenses
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Hwang Man-Seong
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Abstract
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Article 347 of criminal law provides the act of deceiving another, thereby taking property or obtaining pecuniary advantage from another. On the other hand, the concepts of fraud and abuse are confused upon interpretation since the definition in National Healthcare Insurance Law is unclear, and it affects closely to the administrative measures such as surcharge levy by the period of inspection, therefore, the disputes continue in the forms of formal objection, administrative ruling and administrative litigation. This study aims to look over the legal problems on application of criminal fraud toward the abuse of ‘Paid Medical Expenses(Article 57, Sections 1 and 4 of the National Health Insurance Act)’. The main issues are concept of abuse(Article 57, Sections 1 and 4 of the National Health Insurance Act), the problems of Directions of Health-Welfare Ministry on aspect of ‘Nullum crimen sine lege’ Principles, the proper sentencing guidelines of fraud.
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KEYWORD
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Fraud, Abuse, Health care fraud, National health insurance law, Paid Medical Expenses
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