Federal Insurance Office denounces health insurance companies

Waste, fraud and legal violations in the statutory health insurance

15/08/2012

The Federal Insurance Office examined the expenditure and structures of numerous health insurance companies. At some funds, the investigators uncovered numerous embezzlement, sloppiness and unnecessary expenses. The Kassenaufsicht accuses the health insurance companies, not always correctly to deal with the funds of the contributors.

Every year, the statutory health insurance companies spend billions of dollars. The bulk of the expenses are caused by pharmaceutical manufacturers, clinics and doctors. Reason enough to regularly supervise the cash registers to uncover unnecessary expenses. In many cases, the state supervisory authority also exposed sloppiness, embezzlement, waste and nonsensical investment of the insurance premiums, as can be read in the current activity report of the Federal Insurance Office.

Detectives for very small amounts
For example, a health insurance fund used detectives to detect a suspected abuse of sickness benefits. The detective agency demanded for the days-long observation of the alleged perpetrator 10,719 euros. „The health insurance tried to avoid a financial loss of 14.96 euros per day“, it says in the report. If the totals are compared, it shows that this procedure, according to the examiner „grossly uneconomical and negligent“ is.

Fraud of a cashier
In another case, the analysis revealed that a cashier made 213 transfers to ten different bank accounts for over eight years. At the apparent embezzlement so almost half a million euros (459,000 euros) were unlawfully and with criminal energy embezzled. In the course of this demanded the inspection service of the health insurance „to take more precautions against embezzlement“. The current instances are obviously not enough to expose fraud.

Elaborate and expensive renovations
In many cases, the coffers were also noticeable because many leases of office space were completely overpriced. Other funds showed problems in correctly recording and determining contributions. The last-mentioned difficulties were the most frequent sources of error among the health insurance companies. A cash register let its business premises renovate elaborately. For this purpose, an electrical engineering master was commissioned, who then carried out the additional plumbing and painting work. The problem: For further orders, the master was not allowed at all. But the craftsman was a member of the board of directors of the health insurance. Due to the misdemeanor, the company and the cashier must each pay 50,000 euros penalty.

In another case, a health insurance company rented 4152 square meters of refurbished office space for its headquarters. Afterwards, the rooms were left almost empty. Of the originally planned 117 jobs, only 40 places were occupied. In addition, the examiners found that another floor of 633 square meters was rented, which is still empty when it is empty. The auditors found that the total rent costs € 13 million for an existing ten-year period. The reason: „The affected health insurance has now been absorbed by a merger in another fund“. The rent still has to be paid.

Some health insurers noticed the reviewers as unusually generous in the representation and hospitality of employees. Hundreds of thousands were spent on company functions alone.

Surpluses are not invested adequately
Due to the billions of surpluses of the statutory health insurance, critics increasingly raise the question of how the additional revenue will be invested profitably. Health economists criticize the fact that numerous health insurance companies refrain from providing sufficient diversification of the financial assets and trying out different investments. „If the funds were invested widely, risks could be minimized during the financial crisis.“ Last year, all health insurances collectively collected around 184 billion euros and spent about 180 billion euros. Thus, a net income of four billion euros plus the additional income from previous years.

By coding more money from the health fund
In one case, the Federal Insurance Office threatens even criminal consequences. This involves the assignment of individual insured whose illnesses have been added to specific lists of given diagnoses. To understand: If an insured laments one of 80 specific illnesses, the health insurance receives statutory supplements from the health fund. Thus, a financial equalization should be done so that funds are not additionally overly burdened financially when patients suffer from costly diseases. But just that principle allows the coffers to more money „ergaunern“, as could be determined in some cases. For example, a health insurance company used a program to regularly search the data of the insured and asked clinics to make corrections to the previously reported diagnoses in order to receive more money from the health fund. Based on these findings, the Federal Insurance Office announced, „to act consistently against such legal violations“.

According to the legislator's requirements, the examiners should check a health insurance fund at least every five years. Specifically, there are 135 employees employed in the authority. In total, the audit authority undertook 236 reviews last year. Accordingly, there were 15 more evaluations compared to the previous year. (Sb)

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Picture: Rainer Sturm, Pixelio