Billing fraud at the Schwerin Helios Clinic?

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Billing fraud at the Schwerin Helios Clinic? Health insurance companies file criminal charges for inconsistencies in the billing of treatments in the field of plastic surgery.

Three health insurance companies have filed a complaint with the Schwerin public prosecutor against a doctor at the Helios clinic for billing fraud. The clinic admitted "inconsistencies regarding accounting issues of plastic surgery".

After the medical service and several health insurance companies in Mecklenburg-Western Pomerania found inconsistencies in the billing of various treatments in the field of plastic surgery at the Helios Clinic, three health insurance companies filed a complaint with the public prosecutor's office in Schwerin. As the prosecutor announced on Tuesday, several ads are currently being examined. The management of the Helios Clinic took consequences in May 2010 after the first allegations of accounting fraud. Since then, the doctors in plastic surgery have been supported more intensively than before with the coding of their cases and all individual cases are checked internally in the medical controlling department. In addition, checks are carried out daily and central training courses on coding are offered annually, according to the statement in the Helios Clinic's statement.

Health insurance companies file a complaint about billing fraud Both the Barmer GEK, the Techniker Krankenkasse (TK) and the AOK have filed a complaint with the public prosecutor's office in Schwerin about billing fraud. After the medical service of the health insurance companies (MDK) apparently first came across the questionable practice in the Helios clinic, the AOK called in its internal invoice control, the so-called task force, and found several inconsistencies in the verification of the supporting documents. The AOK will then file a complaint about billing fraud. The Barmer GEK has so far handed over ten cases to the public prosecutor's office and 30 further cases are in preparation according to the company. TK also identified 28 cases in 2010 in the examination of 60 percent of the approximately 3,500 treatment cases of its insured persons in the Helios clinic in 2010 and reported two of them. In addition, the TK found that in 2010 the Helios Clinic treated around 20 percent more insured than in the previous year, which meant a cost increase of 17 percent for the health insurance company.

Breast cancer surgery billed even though there was no breast cancer According to the broadcaster "NDR 1 Radio MV", the health insurance companies found that, for example, breast cancer surgery was billed even though the patient did not suffer from breast cancer. In another case, the treatment costs for an acute burn were also billed, although the patient only went to the clinic 40 years after the burn to have his scars treated. This one case alone caused the insurance company a loss of around 30,000 euros. According to the health insurance companies, it has so far been difficult to estimate how high the total damage could be. Overall, however, incorrect billing of doctors and hospitals is a growing problem, as confirmed by the TK's figures for annual recovery due to billing irregularities. According to the TK, these have risen continuously in recent years. While the TK in 2005 still demanded 22 million euros in claims back from service providers nationwide, in 2010 the figure was more than 84 million euros.

Complex coding procedure is often the cause of billing errors. However, deliberate billing fraud is rarely to be assumed, but a large part of the billing error is simply caused by the enormously complex coding process of the diseases or the corresponding medical services. However, according to health insurers, the number of deliberately falsified bills has increased significantly in recent years. Not least because of the increased competitive pressure in the health care system, doctors are repeatedly being tricked into coding to generate additional income. According to the current allegations, the doctor who has now been reported has also used this opportunity to counter the financial pressure on the Helios Clinic, which has increased significantly since privatization in 2005. However, the clinic management did not want to comment on possible personnel consequences for the time being, but emphasized that the allegations were discussed with the health insurance companies concerned. The clinic and health insurers have agreed on how to proceed, the AOK also confirmed. Compared to the previous year, there has been a clear increase in incorrect billing in the healthcare sector. (fp)

Also read:
AOK Bayern has to pay back 91 million euros
PKV increases its contributions from 2011
Health insurers are approving fewer and fewer treatments
Incorrect healthcare billing

Image: Gerd Altmann / /

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