Government legislation ministry rules false workplace insurance reports not fraud

The Ministry of Government Legislation said in a response to inquiry case 26-0235 that a person who reports eligibility for workplace-based health insurance despite not qualifying, but receives medical benefits, does not count as having obtained those benefits through deception under Article 57 of the National Health Insurance Act.

The ministry concluded that the legal definition of deception applies specifically to fraudulent claims during the benefit payment stage, rather than errors made when acquiring insurance status. Since all insured residents are entitled to the same level of medical coverage regardless of whether they are classified as workplace or regional members, the state suffers no actual financial loss from the classification error alone. The ministry noted that interpreting the law to penalize qualification-stage errors would constitute an excessive expansion of the statute's text.

An individual found to be ineligible for workplace insurance after enrollment automatically reverts to regional insurance status retroactively to the date they lost their workplace qualification. This ensures continuous coverage without creating a gap that would justify reclaiming previously paid benefits.

While the individual beneficiary faces no penalty for the status error, employers who register ineligible workers as workplace members remain subject to surcharges under Article 78-2 of the act.