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Billing fraud: DAK health insurance company claims two million euros back
Billing fraud in health care: The German Employee Health Insurance (DAK) tackles bill fraudsters. When reviewing the accounts from 2010, experts at the DAK found and complained about numerous inconsistencies. The cash register now demands a total of 2 million euros.
There are always errors in the billing of medication and medical services, which lead to considerable additional costs for the statutory health insurance companies. The DAK therefore tries to find out more about the submitted accounts, especially the willful accounting fraudsters. Not least because of the significantly improved research methods, more and more manipulated accounts have been noticed in the past from year to year. For 2010, the DAK claimed around two million euros from the service providers due to incorrect billing.
Billing fraud increases by more than 50 percent
According to information from the DAK headquarters in Hamburg, the two million euros were only collected again in cases of deliberate accounting fraud with a criminal background or in breach of contract (as contractual penalties). The normal billing corrections are not included in the total. The DAK experts followed up almost 1,000 new clues in 2010, with investigators completing 861 cases, an increase of 56 percent over the previous year. The total amount of repayments requested increased by 52 percent compared to 2009. The DAK chief investigator Volker zur Heide said that the results for 2010 show "that we can identify more fraudsters and 'black sheep' through improved research methods and thus get more money back for our insured." Because although the broad mass of service providers bills according to the contract and According to the chief investigator, manipulated billing occurs in all areas of the healthcare system.
Billing fraud in all areas of the health care system
During their review, the DAK experts identified a clear focus on accounting fraud in the area of medicinal products, such as massages or speech therapies. 37 percent of all manipulated bills concerned this sector. According to the DAK, the billing fraud for medical services (11.4 percent), care (10.8 percent) and aids (10.4 percent) such as wheelchairs and hearing aids were also striking. However, the required repayments were highest in another area: at the pharmacies. While only 6.6 percent of cases involved manipulated drug bills, the damage done here far exceeds the other areas. The pharmacies have to raise around 600,000 euros out of a total of around two million euros in repayments - almost a third of the total, reports the DAK experts. The payments for the billing fraud of the drugs are particularly high, because "in this area (...) it is often a lot of money," said the investigators of the DAK. In a single case, such as the fraudulent settlement of a pharmacist in Lower Saxony with cancer medication, damage would quickly amount to 250,000 euros.
Billing fraud: Stress test for the health system
Overall, the growing number of billing frauds is a significant burden on the healthcare system. Doctors, pharmacies and patients often work closely together in their fraudulent activities, so that manipulated bills are difficult to detect even for DAK investigators. Financial interests do not always have to be in the foreground. Occasionally, a misunderstood willingness to help leads to considerable damage to the health insurance companies, as in the case of the so-called methadone doctor currently being tried by the Lüneburg district court. However, the billing scams are particularly reprehensible if they are used exclusively for enrichment. Because the burdens on the health system, which is already under pressure, are considerable. In this way, the DAK will continue to do everything possible to catch the fraudsters. According to the DAK headquarters, the investigators are currently investigating around 2,000 suspected cases, with close cooperation with other health insurance companies, associations of statutory health insurance physicians and dentists as well as the criminal police and public prosecutor to combat malpractice in the health care system. (fp)
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