In May, the Kleine Zeitung from Austria reported on cases in a pharmacy in Graz - now the Spiegel followed suit: There are said to have been further cases in Linz, Eisenstadt and Vienna. It's always about pharmacies run by the Catholic men's order of the Brothers of Mercy - and the order's hospitals.
An anonymous person contacted the Viennese association Ans Licht, which supports whistleblowers. The person asked for an interview, says Ramin Mirfakhrai: "She had a number of documents that we could check."
The Viennese is known as the lawyer who helped initiate the so-called Ibiza video in 2019. This brought down the then vice-chancellor of the right-wing FPÖ, Heinz-Christian Strache - and with him the government coalition at the time.
Mirfakhrai and his club partner Ursula Bittner now have invoices from the pharmacies of the Brothers of Mercy. Around twenty drugs are listed that were sold to the hospitals' own hospitals at extremely high prices.
Bittner shows the example of the antibiotic Piperacill. There are three numbers in the accounting, firstly the purchase price of 19.49 euros. If the pharmacy sells this medication to an external hospital, then it charges a market surcharge, which then costs 24.15 euros, explains Bittner.
But if the pharmacy sells the drug to its own hospital, it charges 245.09 euros - a surcharge of around 1,000 percent compared to the price for other hospitals.
The Brothers of Mercy operate seven hospitals in Austria. As a result of the extremely expensive medicines that are resold within the order, these could produce a fictitious loss of millions, which the order can have compensated for.
“The assumption is that deficits are being artificially inflated here,” says Bittner. "This means that the hospital has very high costs and can say at the end of the year that there is a big hole." And this would then have to be filled by the federal state and thus by the taxpayers.
The order rejects the suspicion that it is illegally diverting money through overpriced medication bills. In a written statement from the order, which is available to the ARD studio in Vienna, there is talk of “different legal views”.
If you single out individual drug prices, a “distorted picture” emerges, it says in the letter. The prices also include other costs, including for the preparation of medicines, care in hospitals, personnel costs, IT costs and storage. Efforts are being made to make medication billing more understandable.
But charging 245 euros instead of 24 euros for a broad-spectrum antibiotic cannot actually be okay, says health expert Thomas Czypionka from the Vienna Institute for Advanced Studies. From his point of view, piperacillin-tazobactam is not such a complex drug that it justifies a surcharge of around a thousand percent.
“I wouldn’t speak of fraud now, but it’s at least a lack of transparency,” says Czypionka. If a pharmacy in the associated hospital incurs additional costs, these would have to be billed as such and not simply included in the drug prices.
The health expert believes that there is a fundamental problem behind the whole thing that has long existed with the Austrian religious hospitals: "We have a long tradition of disputes between the federal states and the religious orders." In contrast to Germany, the financing system does not cover costs, "but there remains a residue, the so-called business exit."
The orders are arguing with the states because they are left with part of the hospital costs even though they provide their services entirely on behalf of the public sector, says Czypionka.
According to the health expert, a central question must now be clarified: Are the excessive drug prices justified? Was a service provided for this that was not already billed for elsewhere?
Some of the affected federal states, in which the Brothers of Mercy charged excessive drug prices, have reacted. Styria prepared an audit report on the billing in Graz and forwarded it to the public prosecutor's office. In the Linz case, the state of Upper Austria called in the state's own economic regulator.
And in Burgenland there had already been a dispute with the Brothers of Mercy in 2019 over medication billing. The state then withheld subsidies. The order sued for 33 million euros and in the end a settlement was reached. The clinic and pharmacy in Eisenstadt will be transferred to a GmbH in which Burgenland will provide a supervisory board.
