Billing fraud DAK calls for two million euros

Billing fraud: health insurance DAK calls back two million euros

02/17/2011

Accounting Fraud in the Health Care: The German Employees Health Insurance (DAK) is billing fraudsters on the collar. In a review of the settlements from the year 2010, DAK experts have identified and objected to numerous disagreements. The fund is now demanding a total of 2 million euros.

Again and again occur in the billing of medicines and medical services errors that lead to significant additional costs for the statutory health insurance. The DAK therefore tries to come to terms with the intensive review of the submitted bills, especially the wanton billing fraudsters. Not least due to the considerably improved search methods, more manipulated statements have been noticed from year to year in the past. For the year 2010, the DAK demanded around two million euros from the service providers due to incorrect settlements.

Billing fraud increases by more than 50 percent
According to the DAK headquarters in Hamburg, the two million euros have been recovered only in cases of deliberate billing fraud with a criminal background or the breach of contract (as contractual penalties). The normal billing corrections are not included in the total. The experts of the DAK pursued nearly 1,000 new references in 2010, whereby the investigators were able to close 861 cases, which corresponds to an increase of 56 percent over the previous year. The total amount of repayments claimed increased by 52 percent compared to 2009. The DAK chief investigator Volker zur Heide explained, the balance sheet for 2010 show, „that through improved research methods, we were able to identify more scammers and 'black sheep' and thus be able to bring back more money for our insured.“ Although the broad mass of service providers settles according to the contract and is guilty of nothing, according to the chief investigator, manipulated billing occurs in all areas of the healthcare system.

Billing fraud in all areas of the healthcare system
The experts of the DAK have found in their review a clear focus of billing fraud in the field of remedies such as massages or speech therapies. 37 percent of all manipulated accounts related to this sector. Also striking were, according to the DAK, the billing frauds in the medical services (11.4 percent), the care (10.8 percent) and aids (10.4 percent) such as wheelchairs and hearing aids. However, demanded repayments were highest in another area: at pharmacies. Although only 6.6 percent of cases involved manipulated drug billing, the damage done here outweighs the other areas by far. Of the total of around two million euros repayments, the pharmacies have to raise about 600,000 euros - almost a third of the total, report the experts of the DAK. The payments in the billing fraud of drugs are particularly high, because it „in this area (...) often a lot of money“ goes, explained the investigators of the DAK. In a single case, such as the billing fraud of a pharmacist from Lower Saxony, a damage of 250,000 euros would quickly arise.

Billing frauds: Stress test for the health system
Overall, the growing number of billing frauds for the healthcare system is a significant burden. Often physicians, pharmacy and patients work closely together in their fraudulent activities, so that the manipulated statements are difficult to recognize even for the investigators of the DAK. It does not always have financial interests in the foreground. Occasionally, a misunderstood helpfulness leads to significant damage to the health insurance funds, as in the case of the so-called methadone doctor, who is currently being tried in the district court of Lüneburg. However, the billing frauds are particularly reprehensible if they serve exclusively enrichment. After all, the burdens on the already severely under pressure health system are considerable. Thus, the DAK will continue to do everything in the future to catch the billing fraudsters. According to the DAK head office, the investigators are currently investigating some 2,000 cases of suspicion, with close cooperation with other health insurances, associations of physicians and dentists, as well as with the criminal police and public prosecutor's office in order to combat misconduct. (Fp)

Read about billing and health care:
Wrong bills in health care
Clinics: Billions due to bad billing?
Raid on a Hamburg doctor: suspected fraud
Billions of wrong billing by clinics

Picture: RainerSturm