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Manipulation of the statements: Health insurance companies urge doctors to make multiple diagnoses


Manipulations on a large scale: Health insurance companies cheat doctors on billing
Healthcare corruption and fraud are not really new. But what the boss of the largest German health insurance company now reports is hard to believe. Apparently the cash registers are cheating on a grand scale. They urge doctors to make more diagnoses on patients.

Cheating on diagnoses on a large scale
Only a few months ago it had been reported that pharmacists are investigating fraudulent prescription fraud. And in the summer, AOK Bayern had uncovered millions of dollars in fraud. Healthcare fraud is nothing new. But only manipulations are reported on a very large scale. According to a report by the "Frankfurter Allgemeine Sonntagszeitung" (FAS), the German health insurance companies try to get more money by cheating on diagnoses.

More money from the risk structure adjustment
According to a message from the dpa news agency, the head of the largest German health insurance company TK, Jens Baas, admitted in an interview with the FAS: "There has been competition between the insurance companies over who can get the doctors to do the best for the patients to document many diagnoses. "

There is said to be more money from the risk structure adjustment. "For example, the health insurance companies pay premiums of ten euros per case for doctors if they make the patient sicker on paper." According to the information, there are even contracts with medical associations that aim to achieve more and more serious diagnoses.

In addition, the cash registers were advised in this direction by management consultants. Since 2014, they have spent a billion euros on this that is missing for the treatment of patients.

Regional cash registers cheat particularly intensively
According to Baas, this cheating would be carried out particularly intensively by the regional funds. "In 2016 they will probably get one billion euros more than they need to care for their insured," said the TK boss of the "FAS". According to the newspaper, this apparently meant the AOK funds.

TK does not exempt TK
But his cash register cannot escape it either. Nevertheless, the replacement health insurers, which include TK, would get 700 million euros less than they have to spend this year. It is said that the TK contribution rate could be 0.3 percentage points lower without the manipulations.

"I want the system to be made resistant to manipulation," said Baas, explaining why he is now making the cheats of his and other health insurers public.

Government unnecessarily stirs resentment
In the interview, Baas also criticized the black and red federal government, which wants to keep contributions stable in the 2017 election year and is therefore transferring 1.5 billion euros from the health fund to the health insurers.

The billions of dollars in funding are justified by the costs of treating refugees. But Baas sees it differently: “The refugees are an advanced reason. This is irresponsible because it unnecessarily stirs up resentment towards migrants, ”said the TK boss. So far, the health insurers have had almost no additional costs, as the municipalities are usually still paying for the treatment. (ad)

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