DAK millions of high-payroll accounting fraud

DAK claims 1.6 million in 2013 for billing fraud

03/20/2014

Billing fraud costs the health insurance annually millions, therefore the DAK health goes according to own data consistently against such misconduct. In 2013, the investigators of DAK funds have recovered in the amount of 1.6 million euros and currently are still „nearly 1,900 indications of fake prescriptions, sham treatments or manipulated bills“ pursued, so the current press release of the health insurance.

According to the DAK, billing fraud is recorded in all areas of the German health care system „Remedies such as physiotherapy, physiotherapy or massages with 36 percent“ of the cases examined in 2013 a clear focus. Also in the field of care, a relatively large number of investigations had been required because of the suspicion of billing fraud (16 percent of cases), the statement of the health insurance on. Behind followed „Doctors and drugs each with eight percent“, reports the DAK. Although considerable sums were paid out in 2013 due to incorrect settlements, the DAK emphasizes in its press release that billing fraud „no mass phenomenon“ be.

Billing fraud no mass phenomenon
Volker zur Heide, head of the DAK investigation team, explained that „in the vast majority of service providers the bills correct“ fail and there is no reason to complain. It is true „Misconduct is not a mass phenomenon, but every single case hurts the reputation of the individual areas“, the expert continues. „We owe it to our policyholders to crack down on the fraudsters and bring back the money“, stressed to the heathen. However, the prosecution of billing fraudsters for the health insurance becomes more difficult. Here, it comes increasingly to time-consuming legal disputes, which often prevents a timely compensation of the financial damage. According to its own statements, the DAK works on the clarification of billing fraud and the fight against misconduct in the healthcare sector „closely with other funds, the associations of physicians and dentists as well as the criminal police and the prosecutor's offices together.“

According to the DAK, the successful recoveries for 2013 related to medicines and dressings with 430,000 euros, aids with 340,000 euros, remedies with 290,000 euros, care with 200,000 euros, hospitals with 133,000 euros, doctors with 115,000 Euro, the dentists with 110,000 euros and the ambulance with 23,000 euros. These are exclusively the recoveries resulting from intentional billing fraud with a criminal background or from breach of contract with penalties imposed. The cash returns from the routine audit are not included here. (Fp)