Crime In The Health - Fraud Damages The Health Insurance Bills

The healthcare sector is not free from fraudulent practices. The KKH Alliance has created with its' Billing Fraud Review Group, "a tool to uncover fraud. Last year, the investigators were able to detect 539 cases. But the true figure is expected to be very much.

The largest share of fraud had in the past year physical therapists and physical therapists. In 146 cases, for example, services billed without authorization or uses false certificates. Here, any damage caused by over 124,000 €. In 56 cases, the test group at the pharmacists found it. The black sheep counted as though from the expensive original drugs, but selling cheap imitations or imports. Even a serious fraud has been uncovered of a pharmacist who had cheap components used for cancer drugs from abroad. The examiners requested a total of € 175,000 back to the pharmacists. In third place, the home care ranks with 55 cases and a loss of about 39,000 €. In this area, never performed services billed. Employee of a care service should have been insured gifts so that they mimic a bad health condition.
Unreported cases of fraud is much higher

Overall, the insurance company called back 934 000 €. "The numbers of the KKH Alliance are just the tip of the iceberg," says Anke Martiny, a board member of Transparency, which campaigns against corruption and fraud. There was hardly a deterrent when it comes to the "plundering of the health system" going. The rate of loss can only be permanently reduced if the collusion between doctors, hospitals and pharmacies could be pursued effectively. TI estimates the total damage for the German health care system to 13.5 billion euros annually.
Transparency against fraud

With almost one million euros, the sum reclaimed basically is actually pretty low. The white and Ingo Kailuweit, CEO of KKH alliance. "Unfortunately, it is by no means in all cases to an adequate law enforcement," said Kailuweit. The staffing of the authorities is often not obvious enough, since the issue of fraud in the health care system is complex and difficult. "There is a lack of specialized knowledge too often." Therefore, before proposing Ingo Kailuweit that prosecutors should continue to form. Also could be the patient's receipt of help, where the services are performed. Currently, such a receipt may be required. Would she be given after each doctor's visit without prompting, the compensation could not be prevented by the treatment administered.
Few health insurers seek out fraud

Contribute to the detection of fraud and corruption by providing the team the KKH alliance. In the last ten years, the group uncover nearly 10,000 cases of fraud. This is a considerable contribution to the discovery of fraud in health care, the cost of at least the community of the insured must bear. The detection of cases also designed so difficult, because the scammers are always new ways to invent their own gains. Moreover, not all health insurance companies seek to detect fraud.
Crime is expanding

Apart from the KKH TK alliance pursued in collaboration with the AOK, the incidence of fraud. But not only the inaction of the other funds fraudsters allows too much room. Also the dimension of the fraud is another. The AOK Lower badgers has pointed out that there is a tendency to give criminal networks that operate nationwide. One could even call it almost by organized crime. The AOK Lower Saxony in the near future will present a study on this topic.