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Healthcare costs: 1.5 billion euros a year due to incorrect bills in clinics? Statutory health insurers are estimated to incur an estimated one and a half billion euros a year as a result of incorrect hospital bills, according to statements by the National Association of Statutory Health Insurance Funds. But if a cash register controls a clinic and finds nothing, the cash register faces a penalty.
(04/27/2010) According to statements by the GKV umbrella association, statutory health insurance companies are expected to incur an estimated one and a half billion euros a year due to incorrect hospital bills. But if a cash register controls a clinic and finds nothing, then the cash register faces a penalty, the newspaper “Rheinpfalz” reported yesterday in its edition. That is why the cash registers with controls are extremely reluctant.
Per paying member of a statutory health insurance fund, this could possibly be about 0.15 percent of their gross income, which is added to the contribution obligation. Since the health insurance companies could expect a penalty if the suspicion is not substantiated by the control of a clinic, the statutory health insurance funds are at a disadvantage compared to the clinics. The chairwoman of the board of the GKV umbrella association, Dr. Doris Pfeiffer told Monday's "Rheinpfalz" that she found this understanding of cost reduction to be "strange". It makes more sense not to punish the health insurers with an unfounded check, but to punish the clinics if a suspicion is confirmed. So far, however, the clinics have only had to repay the wrongly collected money. With such a system, it is worthwhile, says Dr. Pfeiffer analogously, at least repeatedly trying to manipulate invoices.
According to media reports, almost half of the bills checked by the Medical Service of Health Insurance (MDK) are about 40 percent higher than the average by around 1100 euros. However, there are also cases where bills were too high by around 100,000 euros according to the MDK. The medical service of the health insurance companies employs experts who are to carry out independent medical and nursing assessments. But you do not intervene, the final decision is left to the health insurers. If an invoice is checked but nothing is objected to, the health insurers should have to pay 300 euros. However, there were no figures on the costs of penalty fees.
Dr. Pfeiffer, who has chaired the GKV umbrella association since 2007, told Rheinpfalz that it could be up to 12 percent of bills from hospitals and clinics that can be described as conspicuous. The GKV umbrella association is the central representative of the statutory health and long-term care insurance funds for Germany and should ensure the framework conditions for statutory health care, provided that it has the opportunity to do so. (TF)