Pharmacist cheats on health insurance companies with HIV drugs?



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A pharmacist in Berlin cheated health insurance companies with the help of HIV patients in the settlement of medication.
(12.11.2010) Pharmacists are alleviating the statutory health insurance companies with the help of HIV-infected people by more than 10 million euros, according to the suspicion of the State Criminal Police Office and the Berlin public prosecutor. On Wednesday and Thursday, the investigative authorities arrested the pharmacist and seven people infected with HIV and searched their homes.

The State Criminal Police Office (LKA) and the Berlin Public Prosecutor's Office carried out eight arrest warrants nationwide on Wednesday and Thursday on suspicion of commercial fraud and searched ten apartments. A pharmacist and seven people infected with HIV are said to have helped health insurance companies millions of dollars with the help of incorrect billing of HIV medication. The investigative authorities speak of a damage of about 10 million euros.

Pharmacist makes common cause with HIV-infected people The 66-year-old arrested pharmacist runs a pharmacy on Kurfürstendamm in Berlin's Charlottenburg district, which has been a point of contact for drug addicts for years. So it was not surprising at the beginning that a particularly large number of HIV medications were allegedly sold over the counter here. However, between 2007 and 2009, the pharmacist is said to have significantly improved his income illegally with the help of those infected with HIV. According to the investigative authorities, the AIDS patients supported the suspicion of the suspect pharmacist with high criminal energy.

10 million damage claims with the health insurance funds The HIV-infected people, who were also arrested, had practiced “doctor tourism” in order to obtain significantly more prescriptions from various doctors than they needed. The pharmacist then bought these prescriptions and settled them at the cash registers without handing over the corresponding medication to the HIV patients, according to the Berlin public prosecutor's office. The investigative authorities reported that the commercial and corporate billing fraud with the prescription of HIV drugs costing an average of 2,000 euros had caused the statutory health insurance companies a loss of at least 10 million euros. The public prosecutor did not want to disclose how much of the illegally obtained money the doctor passed on to the HIV-infected people to buy the prescriptions, for reasons of investigation.

Assets and prescriptions secured during house searches During the house searches carried out on Wednesday and Thursday in Berlin, Schleswig-Holstein and Hesse, the investigators confiscated not only the assets of the accused pharmacist (several luxury cars and other valuables; total value over 200,000 euros), but also numerous prescriptions that confiscated the commercial and corporate accounting fraud. The Berlin public prosecutor's office “assumes that a large number of other investigations can now be initiated”, as its spokesman Martin Steltner emphasized in a joint press release by the police and the Berlin public prosecutor's office.

Pharmacists and doctors generally enjoy a high level of trust. Black sheep are repeatedly noticed among doctors and pharmacists with such fraudulent billing methods. For example, a Hamburg doctor has been arrested in recent days on suspicion of billing fraud. Since the resident doctors and pharmacists have extensive powers in the handling of medicines and their prescription as well as in the billing of treatments, it is only too easily possible for people with the appropriate criminal energy to illegally enrich the system. No wonder that the Verein Berliner Apotheker e.V was particularly dismayed on Thursday in view of the recent fraud. “If the allegation is confirmed, we strongly condemn the conduct. We hope for an unconditional clarification of the facts, ”emphasized the club spokesman Jan Ott. Because the accusation of commercial and corporate billing fraud weighs heavily on the trust that pharmacists generally also enjoy health insurance.

Routine checks would reveal accounting fraud This trust may also be one of the reasons why the current fraud was noticed relatively late. Because it would normally be easy for health insurance companies to briefly check the data of their insured persons for critical positions. All relevant data are available at the settlement offices of the damaged health insurance companies and despite data protection regulations, the medical services should recognize the massive misuse when checking the insured data.

With chronic diseases such as AIDS, only a certain amount of medication is required. If the sums billed are much higher, abuse is very likely. But in order to detect such billing fraud, the insured person's data would have to be checked regularly and this would require significantly more staff. So many health insurance companies still rely on the trustworthy behavior of doctors and pharmacists and therefore only check their data with occasional random checks. Sometimes a mistake, as you can see now. Because a damage sum of more than 10 million euros already requires a huge amount of falsified HIV medication statements (2,000 euros per settlement = 5,000 fake statements with 10 million euros damage). (fp)

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Medicines: Health insurers will soon pay more

Photo credit: Jetti Kuhlemann / pixelio.de

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