Dental Fraud Ring Exposed in Japanese Health Insurance Scam

Dentists Among Seven Arrested in Insurance Fraud Investigation

JAPAN: According to a recent report published in The Asahi Shimbun, Tokyo police have apprehended seven individuals, including dental professionals, in connection with a sophisticated health insurance fraud scheme targeting Nagoya city. The arrests, made on January 16, 2025, reveal an operation that allegedly defrauded the city of approximately ¥20 million ($129,000) through falsified dental treatment claims.

The investigation, led by the Metropolitan Police Department’s international crime division, uncovered a complex operation involving foreign students’ health insurance cards. The suspects reportedly orchestrated false medical fee statements at a dental clinic in Nagoya’s Nishi Ward, claiming treatments for 62 foreign students, predominantly from Nepal, that were never performed.

Key Suspects and Roles

The reported suspects include company executive Yuki Fujiwara (43), dentists Akira Oishi (61) and Hirotaka Koyama (34), organization employee Akihiro Mizutani (35), and a 37-year-old Nepalese national employed at a Japanese language school in Aichi Prefecture. According to investigative sources cited in the Asahi report, each suspect played a specific role in the scheme, which was allegedly spearheaded by Fujiwara and Oishi.

The report highlights significant vulnerabilities in Japan’s medical fee verification system. A metropolitan government official cited in the article noted the challenges in verification, stating that “it is difficult to confirm whether a doctor actually examined the patient.” This difficulty is compounded by the sheer volume of claims processed monthly – with Tokyo alone handling “8 million to 9 million medical fee statements per month,” according to the Tokyo Metropolitan National Health Insurance Organization.

Previous Related Incidents

The investigation follows a similar case from October 2024, where four individuals, including Fujiwara and Oishi, faced fraud charges for a comparable scheme operating through a dental clinic in Tokyo’s Edogawa Ward. This pattern suggests a potentially broader issue within the health insurance system’s verification processes.

The scheme’s targeting of international students appears deliberate, as these individuals may be less likely to recognize or report fraudulent claims. The Asahi report indicates that while fraudulent claims are typically caught when patients receive medical expense notices, the international student victims in this case often only raised queries about unusual notices with their language schools.

Ongoing Investigation

The case remains under investigation by Tokyo police authorities, with the total scope of the fraud still being determined. The situation has drawn attention to potential reforms needed in Japan’s medical fee verification system, particularly concerning vulnerable populations such as international students.