DAK: Millions of high cash register accounting fraud

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DAK reclaimed 1.6 million in 2013 for accounting fraud

Billing fraud costs the health insurance companies millions every year, which is why DAK-Gesundheit takes consistent action against such misconduct. In 2013, the investigators of the DAK recovered 1.6 million euros in funds, and “just under 1,900 references to fake prescriptions, bogus treatments or manipulated bills” are still being tracked, according to the current press release from the health insurance company.

According to the DAK, billing fraud can be recorded in all service areas of the German health system, but the so-called “remedies such as physiotherapy, physiotherapy or massages with 36 percent” of the examined cases in 2013 are a clear focus. In the area of ​​nursing, too, a relatively large number of investigations were necessary because of suspected accounting fraud (16 percent of the cases), the health insurance company said. This was followed by “doctors and medicines, each with eight percent,” reports the DAK. Although considerable sums were paid out in 2013 due to incorrect billing, the DAK expressly emphasized in its press release that billing fraud was “not a mass phenomenon”.

Billing fraud no mass phenomenon Volker zur Heide, head of the DAK investigation group, explained that "for the vast majority of service providers, the bills are correct" and there is no reason for complaint. "Misconduct is not a mass phenomenon, but every single case damages the reputation of the individual areas", the expert continues. "We owe it to our policyholders to act hard and consistently against the fraudsters and to get the money back," said Zur Heide. However, prosecuting accounting fraud is becoming increasingly difficult for health insurers. Here there is an increasing number of time-consuming legal disputes, which often prevents the financial losses that have arisen from being compensated promptly. According to its own statements, the DAK "works closely with other health insurers, the associations of statutory health insurance physicians and statutory health insurance dentists, as well as the criminal police and the public prosecutor's office" to clarify accounting fraud and combat malpractice in the healthcare system.

According to the DAK, the successful reclaims for 2013 concerned the area of ​​medicines and bandages with 430,000 euros, aids with 340,000 euros, remedies with 290,000 euros, nursing with 200,000 euros, hospitals with 133,000 euros and doctors with 115,000 Euros, the dentists with 110,000 euros and the patient transports with 23,000 euros. These are exclusively the claims that have resulted from deliberate billing fraud with a criminal background or from conduct contrary to the contract with imposed contractual penalties. The cash flows from the routine accounting check are not included here. (fp)

Image: Rainer Sturm / pixelio.de

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