Health insurance clinics count massively wrong

Misprints: dispute between health insurance companies and hospitals

06/11/2014

According to the health insurance companies, about every second verified hospital bill in Germany is flawed. The resulting damage is estimated at 2.3 billion euros. The hospitals reject the fraud allegation and say that 95 percent of the bills are correct.

2.3 billion costs for the contributors
According to the health insurance companies, every second verified hospital bill in Germany is faulty. As can be seen from the new figures of the Central Association of Health Insurance Funds (GKV) for the first half of 2013, this cost the contributors under the line around 2.3 billion euros. As in previous years, the presentation of the German Hospital Association (DKG) was rejected as wrong. First had the „Frankfurter Rundschau“ (FR) reported in her Tuesday issue.

Half of the invoices checked incorrectly
Accordingly, a good 52 percent of all verified invoices in the first half of 2013 were incorrect, which corresponded approximately to the level of the two previous years. According to the GKV-Verband, about ten to twelve percent of all hospital bills are scrutinized. In doing so, the auditors noticed achievements that were either not made in the invoiced scope or not at all. It is related to non-administered medication or ventilation hours. The GKV claims to spend € 66 billion a year on clinic treatment.

Different assessment of medical issues
Georg Baum, chief executive of the German Hospital Association (DKG), dismissed the allegations and said: „The statements of the health insurance companies are simply wrong.“ It was pointed out that about 70 percent of medical insurance (MDK) examinations questioned whether patients should have been admitted to the hospital at all or whether they could not have been released earlier. It is not about the amount of the billing, but about a different assessment of medical issues.

95 percent of the bills remained unopposed
The DKG emphasized that, on the other hand, 95 percent of the hospital bills for the total of 18.6 million treatment cases per annum remained unopposed. However, the GKV affirmed its presentation, according to which a good 52 percent of the 2013 audited bills had errors. It is true that only a good one-tenth of all settlements are controlled, so that in fact only five percent of the invoices were in dispute. „But you can not conclude that 95 percent of all bills are correct“, so GKV spokeswoman Ann Marini opposite the FR.

Billing system of the case lump sums up controversy
The reason for the controversy sees the DKG in the billing system of the case lump sums, which again and again meant that „medical issues are assessed differently.“ It is in the claimed 2.3 billion euros to the test volume of the funds. „The actual cut volume is less than half“, so tree. Federal Health Minister Hermann Gröhe (CDU) also pointed out that only ten to twelve percent of all statements were reviewed. The Ministry said: „As a result, this means that not around 50 percent of all hospital bills are flawed, but around five percent.“

Left expert calls „demand“ Funding the hospitals
And also the health policy spokesman for the Left Party in the Bundestag, Harald Weinberg, took sides with the hospitals. The coffers do it „just to keep the hospitals even scarcer“, he criticized. „Many of the bills that are the subject of this trench warfare are debatable, because the coffers criticize what they believe is too long a lay time. Thus, medical considerations directly impact economic demands.“ He demanded one „demand“ Funding the hospitals. (Ad)