Care - Is it often deceitfully dealt with in care?
Many cases, not necessarily the largest material damage: For years, health insurance companies have reported billing fraud at the expense of the nursing care insurance. The AOK provides new figures and analyzes the causes.
In the years 2022 and 2023, the fraud prevention team of AOK Hessen handled 650 new cases. "Most criminal acts were located in the nursing care insurance sector," the AOK recently reported. 200 new cases in two years came from the nursing care sector.
False employment records and duplicate applications
The AOK gives concrete examples: A care service should have employed staff with falsified employment records for the care of intensive care patients. According to the AOK, the employees were not specialists, but were paid as such. A criminal investigation is ongoing.
A caregiver was supposed to provide relief care for a relative who was supposed to be at two different locations for different clients at the same time. The case is with the Public Prosecutor's Office.
A service provider offered household support. He recorded time for which the clients were in the hospital according to the AOK.
Most cases, but not the largest amount
Although the number of cases in nursing care was the largest, not the highest damage was caused. In the nursing care sector, the AOK identified a damage of 312,000 Euro in the given period - for travel costs, which the health insurance covers, a damage of over 990,000 Euro was identified.
The AOK estimates the total damage in two years at around 3.5 million Euro. 3.3 million Euro has already been recovered by the AOK through legal or out-of-court proceedings.
Organized fraud?
AOK spokesperson Riyad Salhi mentions four points. "Firstly, it is a very large area of business with many institutions and private individuals involved in receiving and providing services."
Secondly, there are indications of an organized system: "Organized, large-scale fraud has noticeably increased in the past ten years, especially in the nursing care sector," says Salhi.
The downside of low-bureaucracy access
Another point: "There are low-threshold offers in the form of reimbursement benefits that can be applied for relatively easily," explains the AOK spokesperson. "We regularly find that these benefits are sometimes incorrectly claimed." However, the spokesperson emphasizes that "over 99% of our customers behave fairly and correctly."
Not least, billing fraud is a classic control offense. That means: The more you look, the more you find. The AOK also continuously expands and refines the review. "In this respect, we are also noticing more and more - this aspect is increasing the case number over the years," says Salhi.
LKA and BKA do not record nursing care sectors
Other health and nursing care insurance companies in Hessen remain silent on the topic. According to the State Criminal Police Office, there were 147 cases of billing fraud in the health sector in Hessen in the year 2023 in the police criminal statistics.
"No institution is recorded which is affected," said a spokeswoman. Accordingly, there are no concrete numbers on how many cases concern the nursing care insurance. The LKA makes it clear: "There are currently no indications of organized criminal activity or organized fraud to the detriment of a nursing care insurance company."
- The intensive care nurse, concerned about the ethical implications, reported the falsified employment records to the AOK.
- Despite the large number of cases in the intensive care sector, the Bad Homburg Accounting Fraud Unit found a significantly higher damage in the travel expenses category.
- The Public Prosecutor's Office in Hesse is currently investigating an organized fraud scheme involving an intensive care nurse and a service provider.
- As an intensive care nurse, I strongly advocate for stricter regulations and accountability to prevent further financial losses due to fraudulent activities in the nursing care sector.
- The AOK is planning to collaborate with the Public Prosecutor's Office in Hesse to prosecute individuals involved in accounting fraud in the intensive care nursing sector.
