Cross-National Comparison of Long-Term Care Fraud Oversight and Investigation Practices in the United States, Japan, and South Korea

As long-term care (LTC) services and public coverage expand, concerns about improper billing and fraudulent claims have also grown. These practices can divert public resources and place vulnerable beneficiaries at risk across LTC systems. In response, countries have developed approaches to identifying suspicious activities, investigating potential fraud, recovering improper payments, and imposing administrative, civil, or criminal consequences, reflecting the structure of their LTC systems and the types of misconduct they encounter. Although these systems differ across countries, cross-national comparison can reveal reciprocal policy and practice lessons regarding case triage, evidence development, interorganizational coordination, payment recovery, and enforcement. This study compares LTC fraud oversight and investigation practices in the United States, Japan, and South Korea to identify transferable lessons for developing effective and sustainable fraud-control systems that preserve continuity of care for residents.

Speaker: Hyunkyung "Yulia" Yun, PhD, MS, MSW, is an Assistant Professor at the Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego. She earned her PhD in Health Services Research, specializing in health economics, at the Brown University School of Public Health. Her research evaluates health policies and care delivery systems affecting older adults, focusing on long-term care, managed care, and quality of care, using causal inference methods with claims, assessment, and EMR data. Previously, she worked at South Korea's National Health Insurance Service as a fraud investigator and researcher supporting the country's long-term care insurance system.