보험사기 대응 사각지대 해소를 위한 법⋅제도적 개선방안 — 사무장 병원을 중심으로—

People pursue economic stability against various contingencies, and the insurance industry has continued to develop accordingly. On the other hand, the wrong desire to fraudulently abuse the insurance system is also increasing. Due to the nature of the insurance system, which is characterized by chance and speculation, efforts must be made to eradicate insurance fraud, which involves misunderstanding the insurance system and attempting to make a fortune through it, as it has many social side effects. In order to prevent insurance money leaks, insurance companies need to thoroughly review claims when making claims payments. This is also essential in terms of rationally managing the insurance premiums of good policyholders. In addition, laws and systems must be improved by changing the public's perception of the insurance system. And when the insurance crime detection system is systemized throughout society, the dysfunction of insurance will be overcome and the true benefits of insurance will be enjoyed. In order to fundamentally eradicate insurance fraud, there must be multifaceted self-rescue efforts by the industry through the activation of insurance fraud prevention teams, and the government must take the lead and urgently prepare a legal and institutional framework and a scientific management system and engage in solidarity activities. must be strengthened. Although strengthening the punishment is not a solution, it is necessary to call attention to the fact that it will be dealt with severely and strengthen publicity. Above all, we must actively guide people to change their consciousness and actively promote the meaning and good use of the insurance system. Only when such a comprehensive device is in place can abuses surrounding insurance, such as those of office managers and hospitals, be prevented. The problem at hospital for those who cannot open a medical institution involves complex issues that are intertwined with various issues. In order to solve the problem, much consideration must be given from a legislative, interpretive, legal theoretical, and policy perspective. Nevertheless, since the issue is critical, efforts must be made from various angles to quickly resolve the issue. Experts must gather their wisdom, discuss, and seek solutions through policy verification. As a concrete measure, the Special Act on Prevention of Insurance Fraud should be revised. Within the revision, new regulations must be established that provide a legal basis for claiming the return of unfair profits. Furthermore, a government-wide countermeasures organization should be established to serve as a control tower. It is also necessary to create a new exception to the Personal Information Protection Act in relation to data collection by the government-wide countermeasures organization. When these various systems are introduced and operate organically, effective measures can be implemented to eliminate blind spots in insurance fraud.