Federal Insurance Office denounces health insurance companies

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Waste, fraud and legal violations by the statutory health insurance companies

The Federal Insurance Office examined the expenses and structures of numerous health insurance companies. At some cash registers, the investigators discovered numerous embezzlements, sloppiness and unnecessary expenses. The health insurance fund accuses the health insurance companies of not always handling the funds of the contributors correctly.

Statutory health insurance companies spend billions of dollars every year. The main burden of expenditure is caused by pharmaceutical manufacturers, clinics and doctors. Reason enough to monitor the cash registers regularly in order to uncover unnecessary expenses. In numerous cases, the state treasury also uncovered sloppiness, embezzlement, waste and senseless investments in insurance premiums, as can be read in the current activity report of the Federal Insurance Office.

Detectives for small amounts For example, a health insurance company used detectives to detect suspected misuse of sick pay. The detective agency charged 10,719 euros for the day-long observation of the alleged perpetrator. "The health insurance company tried to avoid money damage of EUR 14.96 a day," says the report. If the sums are compared, it can be seen that, according to the auditors, this procedure is "grossly uneconomical and negligent".

Fraud of a cashier
In another case, the analysis revealed that a cashier made 213 transfers to ten different bank accounts over eight years. In the apparent embezzlement, almost half a million euros (459,000 euros) were illegally embezzled and with criminal energy. In the course of this, the inspection service asked the health insurance companies to "take more precautions against embezzlement". The current instances are obviously not enough to disclose fraud.

Elaborate and expensive renovations
In many cases, the cash registers also stood out due to the fact that many leases for office space were completely overpriced. Other health insurance companies showed problems in correctly recording and determining the contributions. The latter difficulties were the most common sources of error for health insurance companies. A cash register had his business premises renovated extensively. For this, an electrical engineering master was commissioned to subsequently carry out the sanitary and painting work. The problem: however, the master was not admitted for further orders. But the craftsman was a member of the board of the health insurance. Due to the administrative offense, the company and the cash register must each pay a fine of 50,000 euros.

In another case, a health insurance company rented 4152 square meters of high-quality refurbished office space for its headquarters. Afterwards the rooms were left almost empty. Of the originally planned 117 jobs, just 40 were filled. In addition, the inspectors found that another floor with a size of 633 square meters was rented, which is still vacant. The auditors determined that the total rent for a ten-year period would cost 13 million euros. The reason: "The health insurance company concerned has now been absorbed by a merger in another health insurance fund". The rent still has to be paid.

Some health insurance companies noticed the reviewers in that they act unusually generously when representing and entertaining employees. Hundreds of thousands were spent on company parties alone.

Surpluses are not adequately invested
Due to the billions of surpluses in statutory health insurance, critics are increasingly raising the question of how the additional income will be invested profitably. Health economists criticize the fact that numerous health insurance companies refrain from ensuring that financial investments are sufficiently diversified and that various investments are tried out. "If the funds were spread widely, risks in times of the financial crisis could be minimized." Last year, all health insurers took a total of around € 184 billion and spent around € 180 billion. This leaves an annual surplus of four billion euros plus the additional income generated from previous years.

By coding more money from the health fund
In one case, the Federal Insurance Office even threatens criminal consequences. This involves assigning individual insured persons whose illnesses have been added to special lists of predefined diagnoses. For your understanding: If an insured person complains of one of 80 specific illnesses, the health insurance company receives statutory supplements from the health fund. This is to provide financial compensation so that health insurance companies are not burdened excessively if patients suffer from cost-intensive illnesses. But it is precisely this principle that enables the health insurance companies to “steal” additional money, as could be determined in some cases. For example, a health insurance company had a program search the insured person's data regularly and requested clinics to correct the diagnoses already reported in order to receive more money from the health fund. Based on these findings, the Federal Insurance Office announced that it would “take consistent action against such violations of the law”.

According to the requirements of the legislator, the examiners should check a health insurance fund at least every five years. The agency has 135 employees specifically for this purpose. Overall, the audit authority undertook 236 reviews last year. Compared to the previous year, there were 15 more evaluations. (sb)

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