to be needy, The money for care just. This year alone, funds were lacking for the care of about three billion Euro, warns the Federal Minister of health, Jens Spahn (CDU) and the care contributions increase. There are other options: Up to two-thirds of the deficit could be avoided, criminologists estimate, if you decided against scammers pre-Inge. This plunder more and more maintenance funds. But the majority of the insurance companies failed to stop the criminal Goings-on halt.
the methods of The fraudsters are: care services are expected to work, although members have cared for the sick. You smuggle allegedly provided services in the Billings, unskilled care workers with fake certificates as qualified employees, employ fewer nurses than the cash you paid. Also gangs of organized crime to engage in the self-service system of care.
According to SPIEGEL information, the health insurance funds, Germany’s 2016 and 2017, together 14 million euros in damage due to payroll fraud in the ambulatory care successfully claimed back – twice as much as in the two previous years, and more than ever. But, compared with the real damage this sum is ridiculously low. Experts estimate that fraud alone in the outpatient care of around two billion euros are lost annually.
A draft internal report for the Federal Ministry of health, the leading Association of the statutory health insurance funds (GKV-SV) has just created that shows the extent of the problem. He brings together the analysis of the Misconduct of all of the statutory funds. The 55-page paper, the MIRROR, gives a disturbing insight into the care fraud in Germany and signed at the same time, in combination with data from several insurance companies is a sobering picture of the work of many health insurance companies.
care fraud, number one
put The care sector has developed to a Paradise for scammers: according to The report, the health insurance companies in 2017 came back for the first time, most of the money in case of wrong billing in the care. The number of newly detected cases increased rapidly. In the past, been required in fraud with medicines, the largest of Damages.
most of The funds to keep the activity reports of their Misconduct before the Public prefer to be under lock and key. Probably for a good reason.
“Many health insurance companies have done in spite of the spread of fraud in the out-patient care very little about it,” says a Fund expert. “It is an unpopular topic. The majority of companies, it is too time-consuming, because often a large number of small individual positions for evidence of settlement must be examined.”
The discrepancy between the funds is huge when it comes to the success in the fight against fraud. Only a few stand out, prove that the insurance fraudsters is quite the craft. Of the total of more than 110 statutory funds information to the LEVEL-five-AOK-insurance 40 percent of the fraud loss in outpatient care brought in the past two years.
Alone, the AOK lower Saxony and Bavaria secured a quarter of the total. Both are regarded by experts as particularly active in the fight against crime. In contrast, some other AOKs, but especially the operation of health insurance companies held back from striking, say experts. The six replacement funds, such as technicians, Barmer, DAK and KKH could do thus much more.
“An indictment of the funds”
holding the value of the Executive boards of The funds for Uncovering fraud in the healthcare system overall, for a little note that says a fraud fighter. “In the face of your billion in business many managers to see the few million euros that could bring back your investigators so far, apparently, as a little significant,” said another expert on the scene. “It is a poverty certificate for the funds that you have to force them to fight against the care fraud. After all, it’s not your money you can steal here.”
Many of the investigative units of the insurance companies lacked the staff necessary to criticize professionals. Most Teams work only with a little more than a handful of employees. In the case of successful Fraud of the funds, such as the AOK lower Saxony research, however, at least a dozen specialists for fraudsters. The AOK Bavaria has recognized five employees solely on the topic of care fraud, and for years it has been the staff.
is How much staff is actually needed, speaks from the Letter to the investigators: “The combat misconduct in the health sector will increasingly be determined by years of resource-intensive large-scale cases”, so the Shi-experts in their report. The cases would be “larger and more complex”. The processing of maintenance cases was “very time-consuming and expensive”, – stated in the activity report of the AOK lower Saxony.
allegation of accounting fraud: RAID by plainclothes officers in a span duration of nursing service,
in fact, the fraud is in the billions
And it would actually bring much to the fight against fraud. “We assume that the identified cases represent only the tip of the iceberg,” says a gracious speaker. However, The amount of actual fraud damages is not yet recorded in Germany.
in This case, such Figures would be an important incentive for more determination by cash, the police and state Prosecutor’s offices: criminologists estimate that health care fraud, five to ten percent of the total budget to be diverted. On the Federal annual expenditure in outpatient care-wide expected of around € 20 billion, would come there alone one to two billion euros.
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In your current activity report calculates the AOK Bayern: Under you that you would be cheated as a Fund of “only” one percent of the expenditure in outpatient care, this corresponds to an amount of more than Euro 25 million for the year 2017. It’s quite enough investigators.
The investigators of some of the funds reflected in your Reports Alarm given the preponderance of scammers. “The care fraud is characterized by an enormous maximize profits at relatively low risk of Detection”, write the investigators of the AOK lower Saxony. It was “a further substantial increase in the area of care”.
it is not Easy to get the money to the Criminals. Criminals care services often go into bankruptcy in order to evade the access of the cashier’s office investigators. And you give as little information about their work. Your fraud is exposed, you to open a new company in a different state and get straightforward approval, because the health insurance exchange is hardly about criminal care services. A nationwide fraud database is missing.
That in the care industry, now more and more cases of fraud come to light, to new rules of the Medical services of health insurances (MDK), the control since the end of 2016, a year in addition to the quality of outpatient care also of the accounts. The number of external references to possible fraud had increased in 2016 and 2017, also therefore, one-third, of the Shi report. The AOK Bavaria, for example, registered a daily-to-two eye-catching test reports of the MDK.
Alone in 2017 sent to the MDK controller around 5700 notes on abnormalities in the coffers – and, although the reviewers are not nearly as efficient as they could be. It is missing according to the experts, for the Payroll check well-trained employees. In addition, MDK-auditor to report their annual Checks, care services before so they can prepare. “The MDK inspections should always be unannounced”, asks Dina Michels, chief investigator of the replacement Fund KKH. Funds don’t send the MDK in addition, very often, to unannounced inspections, to a suspicion.
only the individual funds would not need to do more. Without a closer cooperation in the health sector, the Criminal is not the craft. Because scammers cupping often different health insurance companies can realize a business alone is never the full extent of the fraud. In-depth examinations of conspicuous care companies are only possible together. So far, funds to cooperate but only in a few länder. The Federal court of auditors had demanded about ten years ago, a closer cooperation to effectively combat misconduct.
“We need more cooperation. There is important information missing to us,” complains a Fund investigators. But all companies are not ready. They consider themselves primarily as competitors.
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