Billing fraud with health insurance companies is increasing

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DAK reports a massive increase in accounting fraud

Times for doctors and other health care providers are apparently getting worse. At least the rising number of cases of billing fraud determined by the German Employee Health Insurance Fund (DAK) point to an additional financial need of some doctors.

The increasing number of fake prescriptions and manipulated bills speak for "increasing criminal energy among service providers" in the German health system, explained the head of the DAK investigation group, Volker zur Heide. According to the expert, however, the increasing number of cases is “also evidence that our methods of clue checking and case tracking have steadily improved.” In 2011, 1,562 new indications of accounting fraud were checked at DAK, which is an increase of just under the previous year Represents 60 percent.

The masses correctly calculate medical services from necessity makes them inventive and possibly also criminal. At least the growing number of manipulated bills, bogus treatments and fake prescriptions indicate that many healthcare providers are trying to alleviate their financial bottlenecks illegally. “As health care funds become increasingly scarce, some are trying black sheep obviously to secure their income through the targeted manipulation of accounts, ”emphasized the DAK expert Volker zur Heide. According to the head of the investigation group, however, the “broad masses are correct.” However, the study presented by the DAK on Tuesday shows a worrying trend. An increase of almost 60 percent in accounting fraud must be seen as an alarm signal.

Billing fraud in all service areas of the healthcare system With his team of ten investigators, Volker zur Heide checked 1,562 indications of bill fraud last year and reclaimed 1.7 million euros of illegally distributed funds for the DAK. This information refers exclusively to "cases of deliberate accounting fraud with a criminal background, cash flows from the routine accounting check are not included," reports the DAK. In order to investigate possible misconduct, "the investigators work closely with other health insurers, the associations of statutory health insurers and dentist dentists as well as the criminal police and the public prosecutor's office," the DAK said. With regard to the benefits for the approximately 6.6 million DAK insured, the evidence of billing fraud has risen continuously in recent years. According to their own statements, the investigators are currently still processing around 1,800 suspected cases, whereby the perpetrators can be found in all service areas, according to the DAK-Gesundheit. However, there are priorities. In 2011, a particularly large number of references to accounting fraud were received for the so-called remedies "such as physiotherapy, physiotherapy or massages". According to the DAK, about 47 percent of the investigations related to this area. The second and third most common are mouse cheating in the field of care and medical treatment with 13 percent and 12 percent of the investigated evidence.

Investigators of the health insurance companies want to prevent misconduct. The investigated cases of billing fraud have become "increasingly complex and the handling of cases ever more extensive in recent years," explains Volker zur Heide. In addition, it can be seen that "the service providers are increasingly engaging lawyers, which also delays the proceedings," said the expert. In addition, the work of the investigators is complicated by the initiation of insolvency proceedings against the accused. In the course of the investigation, more and more service providers register for bankruptcy, “which means that claims settlement is no longer possible,” said Zur Heide. But even if ultimately no money can be reclaimed by the fraudsters, the work of the investigators serves "a certain deterrent" and "thereby also increases the inhibition threshold for manipulation in the long term", reports the head of the investigation group. This is a “sustainable success in combating misconduct, even if it cannot be measured in euros,” continued Heide. However, the deterrent has so far shown little effect, otherwise an increase of almost 60 in accounting fraud could hardly be explained. (fp)

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