Every second health insurance company tricks in diseases

Bundesversicherungsamt charges health insurance companies for cheating on illnesses of their insured persons

09/03/2013

The Federal Insurance Office criticized numerous health insurance companies, which seem to cheat vigorously in the information about the diseases of their insured. This is from a report in the newspaper „Rheinische Post“ out. Accordingly, the experts discovered in almost every second health insurance funds abnormalities. According to the BKK, an increase in heart attacks of 280 percent had been reported. Since the amount received by health insurances depends on the age and health of their members, the statistical cheats of serious illness pay off financially to insurers.

59 out of 134 health insurance funds are said to have cheated on statistics for serious illnesses
As the newspaper reports, there is an urgent suspicion that numerous health insurers knowingly cheated on the serious illnesses such as heart attack. The Federal Insurance Office therefore takes many funds in the sights. The authorities discovered abnormalities in 59 of a total of 134 health insurance companies. The authority now demands a statement from the insurer. For example, a BKK reported that there had been an increase of 280 percent in heart attacks among its insured. For all funds together, however, the number had increased only by less than one percent. Similarly, the Federal Insurance Office assesses the data of another insurer, according to which the number of skin ulcers increased by 30 percent. Overall, the number for this disease, however, only increased by 1.5 percent in the entire POS system.

According to the newspaper, the detailed examinations took place at company health insurance funds, an IKK, an AOK and a substitute fund. The insured persons concerned face financial penalties if they fail to explain plausibly the above-average numbers of some illnesses. For example, the Federal Insurance Office could arrange for financial cuts for the funds from the health fund. The amount of money that the individual health insurance companies receive from the health fund depends on the age and state of health of the insured. Thus, the cheats in the serious diseases pay for the cash - the more serious illnesses occur in the insured, the more money is paid.

Coffers in the criticism for savings in the provision
Recently, the funds were due to significant savings in the provision in the criticism. Again „mirror“ In the past week, the statutory health insurance funds reported that they had cut spending on health promotion and anti-stress measures by about 30 percent from 2008 to 2012. According to the news magazine that corresponds to an amount of 3.41 euros per insured, which is just above the statutory value of 2.94 euros. Above all, there have been cuts in the so-called individual measures such as spinal gymnastics or burnout prevention. According to the prevention law planned by the Federal Government, however, more money should actually be spent on health care.

In addition, the health insurance funds are increasingly trying to send sick employees back to work. Federal Health Minister Daniel Bahr (FDP) According to it is understandable that the funds would have to check the sick leave, however, sick leave should not be rejected flat rate, in bulk or after a brief inspection of the file. "The individual case must always be considered and an individual decision made," Bahr told „world“. (Ag)