Medical care - AOK Plus suffering from losses of millions due to billing errors.
Inaccurate billing for medical services has resulted in a million-euro loss for AOK Plus health insurance in Thuringia and Saxony over the past two years. The insurer estimated the damage to be around 1.7 million euros on Monday. Out of the 719 suspected cases of misconduct, 58% were confirmed, it claimed. The main issues were unperformed services, insufficiently qualified staff, and forged documents. In some cases, criminal complaints were made. AOK Plus is the largest health insurance provider in both states with roughly three million statutory health insurance members.
Using underqualified nursing staff while billing for nursing services was given as an example of false billing. The insurer receives information about such cases from patients, investigative authorities, their accounting department employees, or their Medical Services. Health insurance funds have their own departments dedicated to following up on tips of billing fraud and contacting the prosecutor's office if necessary.
There were still 305 open criminal complaints during the observed period, according to AOK Plus. 305 criminal proceedings had also been concluded, with 361 offenders held responsible. For instance, in Thuringia, the Meiningen Public Prosecutor's Office was the primary investigative body for health sector billing fraud.
Most healthcare providers and service partners bill correctly, stressed AOK Plus. However, billing fraud, misconduct, and corruption divert funds from the needed care of sick and dependent individuals. AOK Plus often manages to recover money in cases of false billing, returning 950,000 euros to its members in the past two years.
