Practices between health insurance companies and doctors are illegal

Billion-dollar business: Federal government considers health insurance practices to be illegal
As recently became known, German health insurance companies try to get more money by cheating on diagnoses. Doctors diagnose common diseases such as depression or heart disease in patients for purely financial reasons, but this is illegal. A member of the Left Bundestag speaks of a “form of corruption”.

Doctors are being pushed to make many diagnoses
It has only recently become known that health insurance companies are apparently pushing doctors to make multiple diagnoses. The head of the Techniker Krankenkasse (TK), Jens Baas, said in an interview with the "Frankfurter Allgemeine Sonntagszeitung" (FAS): "There has been competition between the insurance companies about who can get the doctors to do it for them Documenting as many diagnoses as possible for patients. ”But such practices violate the law.

Make patients appear as sick as possible
According to the "Welt am Sonntag" (WamS) reports, it is illegal in the Federal Government's opinion if doctors diagnose depression, heart disease or other common diseases for their patients for purely financial reasons. This emerges from the answer to a small request from the Left Bundestag faction to the government, which is before the WamS.

According to critics such as TK boss Baas, such diagnoses are the target of many of the so-called care structure contracts between doctors and health insurance companies. The diagnoses often do not result in any further recognizable treatment outlay for the doctor.

According to the government, other tricks that health insurance companies apparently use to make their patients appear as ill as possible are also illegal. According to the WamS, this includes orders to external service providers who call patients to go to the doctor, or till employees, so-called coding consultants, who encourage medical practices to change diagnoses afterwards.

Bonuses for additional diagnoses
According to a report by the WamS, the faction asked the government in September. According to this, many health insurance companies pay bonuses to resident doctors through so-called care structure contracts for providing patients with additional diagnoses of common diseases in their practices.

Baas had explained in the FAS: "For example, the health insurance companies pay premiums of ten euros per case for doctors if they make the patient sicker on paper."

Gigantic redistribution mechanism
According to the information, it is about diseases that are relevant for a gigantic redistribution mechanism, the so-called morbidity-oriented risk structure adjustment.

This means that the statutory health insurances' contributions, a good 200 billion euros a year, are distributed, depending on which health insurer and how many people insure them with diagnoses such as diabetes, arthrosis, depression or alcohol addiction.

"A form of corruption"
In the current response, the responsible Federal Ministry of Health is now emphasizing that a "differentiated assessment" of the individual care structure contracts must be carried out in order to check whether they actually lead to better care for the patient through diagnoses.

In addition, the Federal Government's response shows that the number of diagnoses that are relevant for structural adjustment has increased significantly since the controversial contracts came into existence. According to the officials, the number of these diagnoses rose from 2013 to 2015 by 4.6 percent, which is around half more than the average of all diseases.

The spokesman for health economics of the Left Bundestag faction, Harald Weinberg, said according to WamS: "Apparently, the cash desk competition is not only not very patient-friendly, but also criminal."

"If health insurers and doctors agree to waste resources of the community of solidarity, that is a form of corruption for me," said the member of the Bundestag. In his opinion, the supervisory authorities have so far "followed the practices very inadequately". (ad)

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