Clinics billions through incorrect billing?

Health costs: 1.5 billion euros due to false invoices in clinics annually? According to the GKV-Spitzenverband, the statutory health insurance is expected to incur an estimated one and a half billion euros in costs a year through incorrect hospital billing. But if a health insurance check a clinic and find nothing, then the cashier threatens a penalty.

(27.04.2010)According to the GKV-Spitzenverband, the statutory health insurance is expected to incur an estimated one and a half billion euros in costs a year through incorrect hospital billing. But if a health insurance company controls a clinic and does not find anything, then the insurance company faces a fine, reports the newspaper „Rheinpfalz“ in her yesterday's issue. Therefore, the coffers with controls are extremely reserved.

For each paying member of a statutory health insurance fund, this could potentially amount to approximately 0.15 percent of their gross income, which is used to pay the contribution. Since the coffers could expect a fine, if a suspicion is not corroborated by the control of a clinic, the statutory health insurance see the clinics at a disadvantage. The Chairman of the Board of the GKV Spitzenverbandes, Dr. med. Doris Pfeiffer said to the „Rheinpfalz“ from Monday that they have this understanding of cost reduction „strange“ find. It would make more sense not to punish the coffers with unfounded control, but the clinics on confirmation of suspicion. Up to now, however, the clinics only have to pay back the wrongly spent money. With such a system it would be worthwhile Pfeiffer mutatis mutandis, at least always trying to start to manipulate invoices.

According to media reports, almost half of the bills controlled by the Medical Service of Health Insurance Institutions (MDK) are expected to be overstated by around 1100 euros on average at about 40 percent. But there are also cases where bills were about 100 000 euros according to the MDK too high. The medical service of health insurance employs experts who are to carry out independent medical and nursing evaluation. But they do not intervene, the final decision is left to the coffers. If an invoice is checked, but nothing is objected to, then the coffers have to pay 300 euros. However, there were no figures on the costs of penalties here.

Dr. Pfeiffer, who has been the head of the GKV Spitzenverband since 2007, told the Rheinpfalz that up to 12 percent of the bills for hospitals and clinics could be described as conspicuous. The GKV-Spitzenverband is the central representation of interests of the statutory health and long-term care funds for Germany and should provide for the conditions of the statutory health care, in so far as he has the opportunity. (TF)