Deceptive Practices in Health Insurance Firms - Various instances of deceitful practices are prevalent in Merchant's Health Insurance.
In the region of Schleswig-Holstein, the Kaufmännischen Krankenkasse (KKH) experienced a monetary loss exceeding 800,000 euros in 2023 due to fraud, corruption, or falsified documents. Positioning second in Germany, it falls behind Bavaria with approximately 1.8 million euros, and surpasses Mecklenburg-Vorpommern with over 200,000 euros, as declared by KKH. Nationwide, the sum of defrauded funds amounts to around 3.5 million euros.
Unauthorized claims incurred the highest expenses for the Krankenkasse in ambulatory care services, amounting to nearly 1.9 million euros. The pharmaceutical sector was the second most expensive at over one million euros.
Fraud permeates every level
According to KKH, fraud and corruption infiltrate every facet of the healthcare system, including doctor's offices, pharmacies, nursing homes, hospitals, and physiotherapy clinics. In 2022, the healthcare insurance expenditure reached a record high of 274.2 billion euros.
As per KKH's chief investigator, Emil Penkov, "These circumstances might inspire some to take a piece of the 'billion-dollar health system pie.'" However, it's merely a handful of individuals who distort the image of their profession. In specific instances, lives may even be jeopardized, as witnessed in Schleswig-Holstein where an ambulatory care service allegedly billed for services never provided and forged signatures, according to KKH.
"Individuals can report any suspicions to health insurance providers," Penkov stressed. It's crucial for people to comprehend that even the slightest inkling could indicate a complicated fraud system that siphons substantial contributions and denies medical care to insured individuals.
The most frequent informants are the Medical Service (MD), other health insurance providers, and the police.
Corruption within the healthcare system continued to pose a significant challenge in 2023, as witnessed in Schleswig-Holstein with the KKH's financial loss of over 800,000 euros due to fraud or falsified documents.
Despite the escalating costs of unauthorized claims in ambulatory care services and the pharmaceutical sector, the issue of corruption remains a persistent threat to the effective functioning of the healthcare system.
