Study reveals misconduct: Health insurance companies suspect billions in damage due to fraud

The German health insurance companies are sounding the alarm: Every year, incorrect billing results in billions of dollars in damages. The health insurance association therefore wants to conduct its own study to record the number of unreported cases more precisely and strengthen the fight against fraud.

Germany's health insurance companies want to strengthen the fight against fraud in the German healthcare system with their own initiative. “We want to know exactly how high the damage is in Germany due to misconduct,” said Martin Krasney, board member of the National Association of Statutory Health Insurance Funds. According to the insurance companies, the damage could be in the double-digit billion range.

Politicians and health insurance companies have been debating the need for a comprehensive study on incorrect billing for years, without such a survey having been commissioned. The health insurance association therefore initiated its own study. This has been running since the beginning of October and is intended to provide information about the extent of economic crime in the healthcare system. According to the health insurance association, data on this has not yet been recorded in the official crime statistics or in the GKV figures.

According to Krasney, studies from other countries put the dark field at five to ten percent of service expenditure in the respective healthcare system. “In Germany, the amount of damage would be in the double-digit billion range,” he said.

Damage in the hundreds of millions

Krasney said: "The malpractice offices of the health and nursing care insurance companies have been fighting billing fraud and all other forms of misconduct for over 20 years." Because embezzled contribution money would be missing from people's medical and nursing care. According to regularly published results from these bodies, damages in the three-digit million range are proven every year.

The health insurance companies had repeatedly pointed out “a significantly higher number of unreported damages”. Only the bright field is known - the more checks are carried out, the more cases will be discovered. According to their own statements, the health insurance companies also want to be able to make greater use of artificial intelligence and other technical options in order to be able to better counter criminal activities.