CONTENTS
- 1. Details of the Insurance Fraud Attorney's Client's Case
- 2. Matters Assisted by the Insurance Fraud Attorney
- - Denial of the Structure of Intent and Conspiracy in Insurance Fraud
- - Distinguishing between the Substance of Medical Conduct and the Wording of the Documents
- - Proof That the Requirements for Establishing Aiding and Abetting Fraud Were Not Met
- - Pointing Out Contradictions in the Evidence and Room for Doubt
- 3. The Result of the Insurance Fraud Attorney's Case
- - The Concept of Insurance Fraud and the Level of Punishment
- - The Concept of Aiding and Abetting Fraud and the Level of Punishment
- - The Concept of Preparation of a False Medical Certificate and the Level of Punishment
- 4. Methods of Responding to an Insurance Fraud Charge as Organized by the Insurance Fraud Attorney
- - Daeryun LLC's One-Stop Response
1. Details of the Insurance Fraud Attorney's Client's Case
The client who requested assistance from the insurance fraud attorney was a doctor operating a hospital.
The client was investigated by an investigative agency on the ground that insurance benefit claims related to a particular procedure had been made repeatedly during the course of treatment, and was subsequently indicted on charges of violation of the Special Act on Prevention of Insurance Fraud, aiding and abetting fraud, and preparation of a false medical certificate.
The investigative agency determined that, according to certain medical certificates and treatment confirmation documents prepared by the client, there was a discrepancy between the actual content of the treatment and the content of the insurance benefit claims, and on this basis concluded that the client had facilitated the patients' fraudulent acquisition of insurance benefits.
In particular, the suspicion was raised that "the diagnostic content had been falsely recorded to fit the requirements for the payment of insurance benefits," and criminal liability became an issue separately from the appropriateness of the medical conduct itself.
Although the client had merely provided treatment in accordance with normal medical judgment and treatment procedures, and had never conspired in the fraudulent acquisition of insurance benefits or been aware of or condoned it, the client came under even heavier suspicion because of their status as a medical professional.
2. Matters Assisted by the Insurance Fraud Attorney
The insurance fraud attorney provided assistance for the client as follows.
Denial of the Structure of Intent and Conspiracy in Insurance Fraud
Daeryun's insurance fraud attorney contested the intent to commit insurance fraud and the conspiratorial relationship, which were the most central issues in this case.
For punishment under the Special Act on Prevention of Insurance Fraud, awareness of the fraudulent acquisition of insurance benefits and an intention to assist it must be recognized, and the attorney emphasized that no such intent or conspiracy could be inferred from anywhere in the client's treatment records, statements, or the actual content of the medical conduct.
Distinguishing between the Substance of Medical Conduct and the Wording of the Documents
The insurance fraud attorney argued that the wording of the medical certificates and confirmation documents did not in itself amount to false preparation.
Explaining the structural differences among the medical expressions used in the medical field, the records of treatment progress, and the forms required by insurers, the attorney argued that it was impermissible to expand the differences in the manner of recording into a criminal offense.
Proof That the Requirements for Establishing Aiding and Abetting Fraud Were Not Met
Daeryun emphasized that, for the crime of aiding and abetting fraud to be established, the principal offender's awareness of the crime as well as the awareness and intention of aiding are all required.
Accordingly, the attorney proved through specific facts that the client was not in a position to be involved in, or to be aware of or control, the patients' insurance benefit claim process or its outcome.
Pointing Out Contradictions in the Evidence and Room for Doubt
The insurance fraud attorney pointed out the contradictions among the items of evidence submitted by the prosecutor, the selective excerpting, and the reasoning that relied on conjecture.
On this basis, the attorney emphasized that judgment must follow the fundamental principle of criminal trials, that "any reasonable doubt must be resolved in favor of the defendant."
3. The Result of the Insurance Fraud Attorney's Case
As a result, the court determined that the proof of the crime was insufficient with respect to all of the charges of insurance fraud, aiding and abetting fraud, and preparation of a false medical certificate, and pronounced a verdict of acquittal for the client.
This case is a judgment that clearly established that criminal liability cannot be imposed on the basis of suspicion or outcome-focused judgment alone, and this result was made possible by the insurance fraud attorney's systematic construction of the legal arguments and response on the evidence.
The Concept of Insurance Fraud and the Level of Punishment
Insurance fraud refers to conduct in which a person deceives the insurer regarding the occurrence, cause, or content of an insured event and thereby acquires insurance benefits or causes a third party to acquire them.
1. A person who, through an act of insurance fraud, acquires insurance benefits or causes a third party to acquire insurance benefits
When a charge of insurance fraud is recognized, it is punishable under the Special Act on Prevention of Insurance Fraud by imprisonment for not more than 10 years or a fine not exceeding 50 million won.
However, when the gain from insurance fraud is 5 billion won or more, it is subject to aggravated punishment of life imprisonment or imprisonment for not less than 5 years, and when it is 500 million won or more but less than 5 billion won, it is subject to aggravated punishment of imprisonment for a definite term of not less than 3 years.
The Concept of Aiding and Abetting Fraud and the Level of Punishment
Aiding and abetting fraud refers to conduct that facilitates another person's commission of fraud while being aware of it.
Even if a person does not directly acquire insurance benefits, they become subject to criminal punishment if the act of aiding is recognized.
(2) The preceding paragraph shall also apply where, by the methods in the preceding paragraph, a third party is caused to receive property or to obtain a pecuniary benefit.
Article 32 of the Criminal Act (Accessory) (1) A person who aids another in the commission of a crime shall be punished as an accessory.
(2) The punishment of an accessory shall be reduced below that of the principal offender.
When a charge of aiding and abetting fraud is recognized, the offender may be punished within the range of imprisonment for not more than 20 years or a fine not exceeding 50 million won.
The Concept of Preparation of a False Medical Certificate and the Level of Punishment
Preparation of a false medical certificate refers to conduct in which content that differs from the facts of treatment, or is exaggerated, is recorded in documents such as medical certificates and treatment confirmation documents in order to exercise public or private evidentiary force.
When a doctor, oriental medical doctor, dentist, or midwife falsely prepares a medical certificate, they may be punished by imprisonment or imprisonment without labor for not more than 3 years, suspension of qualifications for not more than 7 years, or a fine not exceeding 30 million won.
When a person is simultaneously charged with insurance fraud and preparation of a false medical certificate, the likelihood of a heavy sentence is high, so it is essential to seek the assistance of an insurance fraud attorney.
4. Methods of Responding to an Insurance Fraud Charge as Organized by the Insurance Fraud Attorney
If a doctor or other medical professional is charged with insurance fraud, they should respond as follows.
Situation | Main Risk | Response Strategy |
Diagnosis linked to an insurance benefit claim | Suspicion of insurance fraud | Securing treatment records and the grounds for medical judgment |
Patient insurance benefit dispute | Assertion of aiding and abetting fraud | Clarifying whether there was involvement in the insurance claim |
Challenge raised regarding the medical certificate | Assertion of false preparation | Explaining the recording standards and the medical judgment |
Commencement of investigation | Expansion of criminal liability | Responding with an attorney present from the outset |
Daeryun LLC's One-Stop Response
When a medical professional such as a doctor is charged with insurance fraud, Daeryun LLC has its medical specialist attorneys, insurance fraud attorneys, criminal law specialist attorneys, and evidence investigation center collaborate to provide the following one-stop response service.
- Analysis of the appropriateness of the medical conduct and the medical judgment
- Separate legal response to insurance fraud and aiding and abetting fraud
- Review of the structure for preparing medical certificates and treatment records
- Establishment of strategy and defense for each stage of the investigation and trial
The client was placed in a serious crisis in which they were indicted on a charge of insurance fraud and even faced concern over revocation of their medical license, but, after Daeryun's systematic assistance, they received a verdict of acquittal and were able to protect their license and profession as a medical professional.
An insurance fraud charge raised against a doctor is a matter directly connected to the doctor's license, reputation, and even the survival of the hospital.
If you are being investigated or have been indicted on a charge of insurance fraud, it is more important than anything to accurately delineate the scope of legal liability from the outset with the assistance of an insurance fraud attorney.
If you need legal assistance in a related matter, 🔗Legal Consultation Reservation is available.
This content is based on actual case studies of Daeryun Law LLC with some adaptations, and the copyright belongs to our firm.
Unauthorized reproduction, duplication, or distribution and other copyright infringements may result in legal action under applicable laws.
