Billing fraud with health insurance companies is increasing

DAK reports a massive increase in billing fraud

04/17/2012

The times for doctors and other service providers in the health system are apparently getting worse. At least, the increasing numbers of billing fraud calculated by the German Employees Health Insurance Fund (DAK) point to additional financial needs of some physicians.

The growing number of counterfeit recipes and manipulated bill speak for one „increasing criminal energy among service providers“ in the German health system, said the head of the DAK investigation team, Volker zur Heide. According to the expert, however, the rising case numbers „also a proof that our methods have improved steadily in the review and case tracking.“ In 2011, DAK examined 1,562 new reports of billing fraud, which represents an increase of just under 60 percent compared to the previous year.

The mass corrects medical services correctly
Needs make you inventive and sometimes criminal. At the very least, the growing number of manipulated bills, sham treatments and counterfeit prescriptions suggests that many health care providers are trying to remedy their financial bottlenecks illegally. „As health care funds become increasingly scarce, individuals try black sheep obviously to secure their income through the targeted manipulation of billing“, emphasized the DAK expert Volker zur Heide. The head of the investigation group to the result expects the „wide mass, however, correct.“ However, the study presented by the DAK on Tuesday shows a worrying trend. An increase of almost 60 percent in billing fraud must be considered as an alarm signal.

Billing fraud in all health care services
With its ten-member investigation team Volker zur Heide last year examined 1,562 references to billing fraud and reclaimed for the DAK 1.7 million euros unlawfully distributed funds. This information refers exclusively to „Cases of intentional billing fraud with a criminal background, cash returns from the routine billing audit are not included“, reports the DAK. To come to grips with possible misconduct, „The investigators work closely with other funds, the associations of physicians and dentists, and the criminal police and prosecutors“, so the message of the DAK on. In the services for the approximately 6.6 million DAK insured the evidence on billing fraud in recent years has risen steadily. The investigators are currently working on about 1,800 suspected cases, the perpetrators are in all according to the DAK-health notice in all areas of performance to find. There are, however, priorities. Thus, in 2011, there are many indications of billing fraud in so-called remedies „such as physiotherapy, physiotherapy or massages“ received. About 47 percent of the investigations referred to this area according to DAK. On the second and third most common are mischief in the field of care and medical treatment with 13 percent and 12 percent of the examined evidence.

Investigators of health insurance want to stop misconduct
The investigated cases of billing fraud have been in recent years „more and more complex and the cases are always more extensive“ become, explains Volker to the heath. It should also be noted, „that service providers are increasingly turning to lawyers, which also slows down the proceedings“, explained the expert. In addition, the work of the investigators is hampered by the initiation of insolvency proceedings by the accused. More and more service providers are filing for bankruptcy in the course of the investigation, „whereby a claim settlement is no longer possible“, explained to the Heath. But even if in the end no money can be reclaimed by the fraudsters, the work of the investigators serves „a certain deterrent“ and increased „in the long term, the inhibition threshold for manipulation“, reports the head of the investigation team. This is a „sustainable success of misconduct, even if it can not be measured in euros“, so on to the heath. However, the deterrence seems to have little effect so far, otherwise an increase of just under 60 in accounting fraud would be difficult to explain. (Fp)

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Picture: Rainer Sturm