Record million billing fraud at the KKH

Damage due to billing fraud at the previous highest level

03/27/2014

The Kaufmännische Krankenkasse (KKH) incurred 2.1 million claims in 2013 for billing fraud. Never before has such a high level of damage been detected by cases of fraud at the KKH, the health insurance company reports in a recent press release. The nine-member investigation team has detected 566 fraud cases and filed 21 lawsuits. KKH CEO Ingo Kailuweit emphasized, „It is as unfortunate as it is unacceptable that some black sheep in health care want to enrich themselves illegally and at the expense of the general public.“

According to the KKH, the biggest damage in the area of ​​pharmacies was due to billing fraud. 1.6 million euros, the investigators have reclaimed here. Of this, 600,000 euros were incurred in a single fraud case in which „For years in a medical care center heavily excessive radiographic contrast agent billed“ were. The second highest amount of damage was to be found in the outpatient care services. However, the recoveries totaled only € 144,000 here. In third place with regard to the amount of damage, according to the figures of the KKH, the hospital area follows with 96,000 euros. Most of the newly discovered cases of fraud were found in the field of physiotherapy / physiotherapy, according to the health insurance, but overall the loss was relatively small.

In the current press release, the KKH also points out that „In contrast to billing fraud, the issue of bribery and corruption of health care providers has not yet been legally regulated“ be. Just two years ago, the Federal Court of Justice recommended prosecuting and prosecuting corruption in this area. The chairman of the health committee of the German Bundestag, Edgar Franke (SPD), explained in this regard that the government parties had agreed in the coalition agreement on a corresponding adjustment of the legislation. The plans of the Federal Government are expressly welcomed by the KKH and „We are pleased that the politicians thus want to fulfill a long-standing KKH requirement and anchor a corresponding offense in the penal code“, emphasized Ingo Kailuweit. According to the KKH, corruption in the healthcare sector alone causes billions of dollars worth of economic damage every year in Germany alone. (Fp)