Billing fraud at the Schwerin Helios Clinic?

Billing fraud at the Schwerin Helios Clinic? Health insurance companies filed criminal charges due to discrepancies in the settlement of treatments in the field of plastic surgery.

20.01.2011

Three health insurance companies have filed a complaint with the Schwerin prosecutor against a doctor of the Helios clinic for billing fraud. The clinic cleared „Disagreements on billing issues of plastic surgery“ on.

After the Medical Service and several health insurance found in Mecklenburg-Western Pomerania discrepancies in the settlement of various treatments in the field of plastic surgery Helios Clinic, have three health insurance reported to the prosecutor Schwerin. As the prosecutor announced on Tuesday, several ads are currently being reviewed. The management of the Helios clinic drew consequences in May 2010 after the first allegations of billing fraud. Since then, physicians in plastic surgery have been supported more intensively than before in the coding of their cases, and all individual cases in the department of medical controlling have been internally reviewed. In addition, daily checks are carried out and central training courses are offered every year for coding, according to the statement in the opinion of the Helios Clinic.

Health insurance companies report charges for billing fraud
Both the Barmer GEK, as well as the technicians health insurance (TK) and the AOK have made with the public prosecutor's office Schwerin announcement because of accounting fraud. After obviously the medical service of the health insurance companies (MDK) first encountered the questionable practice in the Helios clinic, the AOK drew their internal audit control, the so-called task force, and noted in the verification of the evidence several discrepancies. The AOK then reports charges for billing fraud. Barmer GEK has handed ten cases to the prosecution and 30 others are in the pipeline, according to the company. TK also found anomalies in 28 cases in 28 cases during the review of 60 percent of the approximately 3,500 treatment cases of its insured persons in the Helios Clinic in 2010, and two of them were reported. In addition, the TK found that in 2010 at the Helios clinic about 20 percent more insured were treated, which meant a cost increase of 17 percent for the health insurance company.

Breast cancer surgery billed although no breast cancer was present
According to the sender „NDR 1 Radio MV“ For example, the health insurance funds have determined that, for example, a breast cancer operation was billed even though the patient did not suffer from breast cancer. Also, in another case, the treatment costs for an acute burn had been accounted for, but the patient did not go to the clinic for 40 years after the burn to have his scars treated. Just by this one case, the insurance incurred a loss of around 30,000 euros. How high the resulting damage could be, according to the health insurance companies so far hardly estimate. Overall, however, bills by physicians and hospitals are a growing problem, as confirmed by TK's figures on the annual recovery due to billing issues. According to the TK, these have risen steadily in recent years. While the TK in 2005 nationwide still 22 million euros reclaimed to the service providers, in 2010 there were more than 84 million euros.

Complex coding often causes billing errors
However, it is rather rarely intentional billing fraud to assume, but a large part of the billing error is simply due to the enormously complex coding of diseases or the corresponding medical services. However, the number of willfully falsified bills has also increased significantly in recent years, according to the health insurance companies. Not least due to the increased competitive pressure in the health care sector, doctors are repeatedly tempted to trick coding, in order to generate additional revenue. According to the current allegations also the now indicated physician used this possibility to counter the financial pressure of the Helios clinic, which had increased significantly since the privatization in the year 2005. For the time being, however, the clinic management did not want to comment on possible personal consequences, but emphasized that the allegations were discussed with the health insurance companies concerned. Clinic and health insurance companies had agreed on the further procedure, also confirmed the AOK. Compared to the previous year, there has been a significant increase in false health care bills. (Fp)

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Picture: Gerd Altmann / dezignus.com