Health insurance More and more billing fraud

Health insurance companies are suffering from increasing billing fraud

05/17/2014

The health insurance in Germany caused by billing fraud damage in the millions. Be it fake prescriptions, undelivered services or excessive billing: The extent of the damage is greater for some funds than ever before. Many of the culprits get away with it.

Rapid increase in damage
By billing fraud go the statutory health insurance in Berlin and Brandenburg every year thousands of euros lost, as a dpa survey found. The KKH alone had incurred a loss of almost 11,000 euros last year, as a speaker of the fund announced. „A rapid increase, considering that in 2012 it was just 62 euros.“ Since there are such manipulations not only with doctors, but also with pharmacies, insured persons, employers and clinics, the cash registers are now increasingly against the fraud. A spokeswoman for the Kassenärztliche Vereinigung Brandenburg said: „In the case of a conviction for fraud, a physician even threatens the withdrawal of approval by the admissions committee.“

Fake prescriptions and never-done services
Typical are fake prescriptions and invoices as well as certificates of incapacity for work. In some cases, billed services would never be provided. In addition, doctors and clinics sometimes drive up bills. Thus, according to the Techniker Krankenkasse (TK) from all over Germany, cases are known in which, for example, a pure breast augmentation as a breast cancer surgery and a relatively small knee surgery were charged as a complex procedure. At Barmer GEK, the number of new cases in Berlin and Brandenburg in 2013 has risen by about a quarter to 202 compared to the previous year. The annual damage amounted to around 180,000 euros. And the IKK Berlin-Brandenburg is also showing an upward trend. In 2012 and 2013, with a total of 71 suspicious cases, there were 20 more than in the previous two years. Across Germany, DAK and TK are currently investigating up to 2,000 suspicious cases.

Damage in the millions
The health insurance companies in Saxony-Anhalt incur losses amounting to millions due to incorrectly billed services. The dpa survey found that last year they were demanding unprecedented compensation from care services, physicians, pharmacists and other service providers. By contrast, the number of suspected billing fraud cases increased only slightly. „Every scam is one too many in our eyes“, said Saxony-Anhalt Medical Council President Simone Heinemann-Meerz. There is cheating in every area of ​​the healthcare system.

Offenders get away with it
On the other hand, there was no indication of billing fraud by the Ergo Insurance Group, as it was called. Just like the statutory health insurance companies, the private departments that investigate suspicions and allegations of fraud have been with Debeka for 15 years. The DAK said that it would be more difficult for the health insurance companies to prosecute fraudsters. Since proceedings are discontinued or the offense is time-barred, many perpetrators would get away with it. According to the health insurance, public prosecutor's offices focusing on medical billing should be introduced. (Ad)