2021 Highest 923 Fraud, National Health Insurance Violation, and Resident Registration Act

A (63 years old, South)

Public trial, or silent (public trial)

May 26, 2021

A defendant shall be punished by imprisonment for not less than eight months.

except that the execution of the above punishment shall be suspended for two years from the date this judgment becomes final and conclusive.

Criminal facts

1. Fraud;

On October 14, 2011, the Defendant received medical services equivalent to KRW 18,460, insurance benefits, and exempted the damaged Corporation or pharmacy operator from the obligation to pay medical expenses, etc. by having the damaged Corporation pay the insurance benefits equivalent to the amount of the insurance benefits, by having the damaged Corporation pay the insurance benefits to the said hospital as the insurance benefits cost, and by having the hospital or pharmacy operator pay the insurance benefits equivalent to KRW 12,445,761, total amount of the insurance benefits, by receiving medical treatment or purchasing medicine over 278 times in total as indicated in the attached list of crimes in the attached list of crimes, and by having the hospital or pharmacy operator pay the insurance benefits equivalent to the amount of the insurance benefits, by having the medical institution or pharmacy operator pay the insurance benefits to the victim as the insurance benefits costs.

Accordingly, the Defendant, by deceiving the damaged Corporation through medical institutions, acquired pecuniary benefits equivalent to 12,445,761 won.

2. Violation of the National Health Insurance Act;

No person shall receive or arrange another person to receive insurance benefits by fraud or other improper means.

Nevertheless, on March 11, 2016, the Defendant received insurance benefits equivalent to KRW 5,773,130 in total from each hospital and pharmacy in a total of 58 times in an unlawful manner, as described in [Attachment Table Nos. 221 through 278] in the same manner as the Defendant received insurance benefits from the above pharmacy by stealing B’s resident registration number in ○○○ pharmacy located in Daegu, as well as from April 17, 2020.

3. Violation of the Resident Registration Act.

No person shall unlawfully use another person's resident registration number.

Nevertheless, on March 11, 2016, the Defendant, at the ○○○ pharmacy located in Daegu on March 11, 2016, submitted to the employees of the medical institution a prescription issued after entering the B’s resident registration number or receiving treatment after having entered the B’s resident registration number, to the employees of the above pharmacy and submitted the prescription issued after receiving the said medical treatment, and used the other person’s resident registration number at each hospital and pharmacy 58 times in total, as described in [Attachment] Nos. 221 through 278 of the List of Crimes, from that time until April 17, 2020.

Summary of Evidence

1. Defendant's legal statement;

1. Protocol of the police statement concerning B;

1. Physical list, etc. for checking each person;

1. A police investigation report (in relation to specific suspect);

1. Report on investigation by the prosecution (to listen to the B phone statement by the victim);

Application of Statutes

1. Article applicable to criminal facts;

(a) Each point of judgment No. 1: Article 347(1) of the Criminal Act;

B. Each point of judgment No. 2 (Unlawful Demand and Supply)

(i) Attached Table 221 to 228: Article 115(2)5 of the former National Health Insurance Act (amended by Act No. 14084, Mar. 22, 2016 and enforced from September 23, 2016)

(2) Attached Table 229: Article 115(3) of the former National Health Insurance Act (amended by Act No. 16366, Apr. 23, 2019 and enforced from October 14, 2019)

Subparagraph 5

(3) Attached 267 through 278: Article 115(3) of the National Health Insurance Act

(c) Each point of judgment No. 3 (Unlawful Use of Resident Registration Numbers);

(1) Attached Table 221: Article 37 subparag. 10 of the former Resident Registration Act (amended by Act No. 14286, Dec. 2, 2016; and enforced from December 3, 2017)

(2) Attached 244 to 278: Article 37 subparag. 10 of the Resident Registration Act

1. Commercial competition;

Between the crimes of fraud and the violation of the National Health Insurance Act in the holding of Articles 40 and 50 of the Criminal Act (attached Table 221 through 278: Punishment provided for in the holding that punishment is more severe)

1. Selection of punishment;

Each Imprisonment Selection

1. Aggravation for concurrent crimes;

The former part of Article 37, Articles 38(1)2 and 38(2) and 50 of the Criminal Act (within the scope of the sum of long-term punishments for the crimes of double-term crimes, the penalty heavier than the penalty prescribed in the judgment of fraud)

1. Suspension of execution;

Article 62(1) of the Criminal Act

Reasons for sentencing

If a person receives national health insurance benefits by stealing another person's resident registration number for a long time and illegal means, the risk of re-offending requires a warning, and thus, the sentence should be suspended in consideration of the defendant's age, family environment, health conditions, etc.

It is so decided as per Disposition for the above reasons.

Judges Kim Jong-type

A person shall be appointed.