Billing fraud, corruption or bribery also occur in the healthcare sector. The AOK Bayern is on the trail of the fraudsters - and calls for the good structures in the state to be built up nationwide. Because so far, the criminals often just move on.
Munich (dpa/lby) - The AOK Bayern has determined damage of around 30 million euros within two years when uncovering billing fraud, corruption and other misconduct in the health care system. This is also due to the nationwide unique structures in the Free State, explained the CEO Irmgard Stippler on Wednesday in Munich and called for a nationwide database that stores cases of fraud on a person-by-person basis.
So far, fraudsters could simply move on to a federal state without the local health and nursing care insurance companies learning about the criminal history, said Stippler. "We are observing that fraudsters are becoming more and more professional," added AOK expert Dominik Schirmer. The legislature should therefore create the possibility for intelligent software programs to evaluate the data from several cash registers together. "With complex analysis tools, billing data can be checked in a targeted manner and fraud patterns can be identified at an early stage," explained Schirmer.
The situation is particularly difficult in nursing, where invoices, duty rosters, etc. are still mostly on paper and are checked by hand. "We therefore urgently need the obligation to bill digitally in care as well," demanded Schirmer. At the same time, Stippler emphasized that it was only a minority whose behavior ultimately harmed not only the profession, but all insured persons.
According to the information, the AOK Bayern alone processed almost 4,200 suspected cases of misconduct in the health care system in 2020 and 2021 - even though fewer checks were carried out in nursing services, for example, due to Corona and therefore around a third fewer new suspected cases were reported. The total damage was still 27.9 million euros - more than twice as high as in the previous years 2018 and 2019. At the same time, Bavaria's largest health insurance company was able to successfully reclaim 12.3 million euros. Since the Misconduct Office was set up in 2004, it has been around 107 million euros.
