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Practices between health insurances and doctors are illegal
As it became known recently, German health insurance companies are trying to get more money through cheating on diagnoses. Diagnosing physicians in patients Common diseases such as depression or heart disease for purely financial reasons, this is illegal. A member of the Bundestag of the left speaks of a "form of corruption".
Doctors are being pushed to many diagnoses
Only recently it became known that health insurance physicians seem to push for multiple diagnoses. As the head of the Techniker Krankenkasse (TK), Jens Baas, explained in an interview with the "Frankfurter Allgemeine Sonntagszeitung" (FAS): "There has been a competition between the coffers over who manages to get the doctors to pay for the Patients to document as many diagnoses as possible. "But such practices violate the law.
According to the federal government, it is illegal for doctors to diagnose their patients for depression, heart disease or other common diseases for purely financial reasons. A left-wing politician speaks in this context of a "form of corruption". (Image: nito / fotolia.com) Let patients appear as ill as possible
As the "Welt am Sonntag" (WamS) reports, it is illegal in the Federal Government's view, when doctors diagnose their patients depression, heart disease or other common diseases for purely financial reasons. This emerges from the answer to a small request from the left-wing parliamentary group to the government, which is the WamS present.
According to critics such as the TK boss Baas such diagnoses are the goal of many of the so-called support structure contracts between doctors and health insurance companies. Often, no further discernible treatment for the physician results from the diagnoses.
According to the government, other tricks apparently used by health insurances to make their patients as ill as possible are unlawful. According to WamS, this includes assignments to external service providers, who call patients to go to the doctor, or cashiers, so-called coding consultants, who encourage medical practices to change diagnoses retrospectively.
Bonuses for additional diagnoses
According to a report by the WamS, the group had put the request to the government in September. Many health insurances pay bonuses for their physicians by way of so-called care structure contracts to provide patients in their practices with additional diagnoses of common diseases.
Baas had explained in the FAS: "The health insurance funds, for example, pay premiums of ten euros per case for physicians, if they make the patient on paper sicker."
Gigantic redistribution mechanism
According to the information, these are diseases that are relevant for a gigantic redistribution mechanism, the so-called morbidity-oriented risk structure compensation.
This has the effect that the health insurances' cash contributions, well over € 200 billion a year, are distributed depending on which health insurance fund, like many patients, is insured with diagnoses such as diabetes, osteoarthritis, depression or alcohol dependence.
"A form of corruption"
The competent Federal Ministry of Health now emphasizes in the current answer that a "differentiated assessment" of the individual care structure contracts must be made to check whether they actually lead to better care for the patients through diagnoses.
In addition, the Federal Government's response shows that the number of diagnoses relevant to structural adjustment has increased significantly since the controversial contracts exist. According to officials, the number of these diagnoses increased by 4.6 percent from 2013 to 2015, more than half the average of all illnesses.
The spokesman for health economics of the Left Bundestag faction, Harald Weinberg, said according to WamS: "Apparently, the box office competition drives not only little patient-friendly, but also criminal blooms."
"If funds and doctors together agree to waste resources of solidarity, that is a form of corruption for me," said the member of the Bundestag. In his opinion, the regulators have so far been "very inadequate" practices. (Ad)