Billions of wrong billing by clinics

Billions lost in the health insurance by billing errors of the clinics.

29/12/2010

The central association of the legal health insurances communicated that by wrong settlements of the hospitals a damage of scarcely one billion euro per year arises - nearly half of all accounts had proven with a test mistake.

According to the presentations of the GKV-Spitzverband, hospitals very often misjudge the services provided. According to a statement made by the Kassenverband, 43 percent of the settlements from 2009 had been proven to be a systematic check. The private health insurance companies (PKV) also report in the light of the results of the investigation and supported the position of the GKV. „Misprints are a big issue“, said Volker Leienbach, association director of PKV to the news agency dapd. The error rate in some clinics even amounted to 65 percent, as reported by the GKV-Spitzenverband. Correct billing would therefore result in a savings volume of at least € 1.02 billion, according to the association's position.

Clinics defend themselves against the accusation
However, the hospitals defend themselves against the statements of the GKV-Spitzenverband: „The charge that hospitals are causing billions in damage is wrong“, stressed Georg Baum, chief executive of the German Hospital Association. In his view, given the complex accounting method, there are certainly „different views between hospital doctors and health insurances“, but what „not to equate with false statements“ be. So must „in the statements with the cash registers (...) out of 10.000 diagnosis numbers and 20,000 treatment numbers the treated individual case are represented“, being there „especially about the duration of the treatments (...) to different views“ get.

Total damage of around one billion euros
According to the association, the medical service of the GKV has reviewed twelve percent of all hospital bills from the year 2009 and found errors in two out of five bills. In an internal paper of the GKV-Spitzenverband they are divided into three different categories of incorrect invoices. Unnecessary hospital stays, unnecessarily long hospital stays and coding errors in the allocation of patients and their illnesses to the so-called case lump sums, on the basis of which the clinics bill for their services. especially the „improper coding of diagnoses and procedures“ lead in this regard „excessive bills“, so the position of the Kassenverbandes. Of course, only a relatively small amount of damage of less than one thousand euros is incurred per case, but the large number of cases adds up and, according to the projections of the association, at the end of the day there is a sum of „potential total damage“ of around one billion euros. In a hospital, for example, 600 births do not have the code P67D for a birth without complications, but falsely P67C for a birth at one „helpless person“ billed, whereby the clinic has collected 720,000 euros too much, so the message of the Kassenverbandes. Overall is „per wrongly billed case an average of 1,100 euros is due“, explained the association.

Complex billing system no excuse
According to the GKV-Spitzenverband, the complaints of hospitals about the complicated billing system can not be cited as an excuse for the mistakes, because the error rate is also high in specialist clinics with predominantly standardized cases. So it says in the internal GKV paper: „Ultimately, a high rate of false reports indicates the lack of billing organization of some hospitals or their intent to calculate higher amounts“. In order to avoid such a large number of incorrect settlements in the future, the statutory health insurance funds demand that hospitals in the future be fined € 300 per wrong bill. So far, billing errors are not penalized and only the health insurance pay the clinics 300 euros, if no error was detected when checking an invoice.

Intensified discussion about the reform of the hospital sector
With the announcement of the calculations of the GKV-Spitzenverband, the current discussion about a reform of the hospital sector is intensifying. Already earlier this week, the CDU health politician Jens Spahn had caused a stir with a whole range of proposals for the restructuring of the hospital sector. Among other things, Spahn demanded a double room for all those insured by law, which up to now has been a privilege of private patients. However, with his plans, Spahn encountered a shared echo. Although the Federal Minister of Health Philipp Rösler (FDP) announced on Tuesday to have double rooms for all insured examine, but the umbrella organization of hospitals rejected the initiative as not financially simple. The legal and private health insurances, meanwhile, demanded to intensify competition among the hospitals. So the health insurance companies demand in the future for cities or regions to write out certain services and to negotiate directly with the clinics contracts for fees and quality standards.

PKV also complains of billing errors
In view of the current publications of the GKV-Spitzenverbandes also complained of the private health insurance director Leienbach the false accounts and excessive costs, although the private insurers have a different accounting system with the clinics than the GKV. For example, head physician treatments are often estimated, although patients were cared for by normal ward physicians, which is often the case, „that the chief physician signs the bill without the patients seeing him“, Leienbach explained. In addition, the bills of doctors in private practice would sometimes make private health insurance companies think-provoking. „We spend five times as much on private health insurance per capita for laboratory medicine as the statutory health insurance, which can not be explained medically“, so the accusation of the private health association director. Generally be „the real problem (...) is that the fee schedule invites you to take advantage of all the leeway and expand the amount“, criticized Leienbach and urged the Federal Minister of Health Philipp Rösler (FDP) urgently to revise the fee regulations. (Fp)

Also read:
Wrong bills in health care
Clinics: Billions due to bad billing?

Picture: Günter Havlena