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Care billing scam

Dagmar BreitenbachApril 18, 2016

The German health care system is losing huge amounts of money to billing scams that are being linked to the Russian mafia. And it's a nationwide phenomenon, Germany's federal police warns.

Holding hands
Image: picture-alliance/dpa/J. Kalaene

Germany's population is aging fast; a fact that has allowed a booming market for health care and nursing services to emerge in recent years.

Due to a shortage of skilled German careworkers, the country increasingly depends on nursing staff from Eastern Europe, both for stationary jobs in nursing homes and for mobile services. But unless mobile nursing services are adequately monitored, it turns out they can quite easily be abused as an invitation to organized crime.

According to German media reports, Germany's healthcare system is currently losing at least 1 billion euros ($1.1 billion) annually to billing fraud.

Welt am Sonntag newspaper and public broadcaster Bayerischer Rundfunk report that the billing scams are allegedly linked to Russian mobile nursing services, some of which are thought to be in league with Russian organized crime. And these services like to target lucrative cases: patients requiring intense care, running up bills of thousands of euros a month. Reportedly, such scams can garner the Russian services up to 15,000 euros per month and patient.

Doors open to abuse

Germany's complicated health system is the main problem in the billing scandal, says Eugen Brysch, CEO of the German Foundation for Patient Rights.

Germans actually have two kinds of mandatory health insurance: basic health insurance and long-term care insurance. "The system makes it easy for criminals," Brysch told DW, "because the two insurances don't communicate at all where care in residential homes is concerned."

At home, a patient's long-term care is usually monitored, more or less, but the health care aspects are only rarely checked, he says, adding that this is a grave shortcoming and a loophole for criminals. "We've been seeing this development for years," CEO Brysch says, urging stricter controls of residential nursing care. "The federal states have downsized their supervision to a minimum."

How it works

Apparently, health workers charged for 24-hour care, for instance, but only checked on their patients a few times a day. Sometimes, patients' family members were part of the fraud, taking a cut of the sum raked in from the German healthcare system. Careworkers also systematically falsified logbooks for services never rendered. It's a nationwide phenomenon, but the focus of the scam appears to be in Berlin, Lower Saxony and Bavaria.

Group of older women with walkers
At least one out of five people in Germany is 65 years or olderImage: picture-alliance/dpa/P. Pleul

The services seem to choose patients where the swindle will be easiest to pull off, says Dominik Schirmer of the AOK health insurance company's Bavarian branch, adding that this particular kind of fraud seems to have been going on systematically all over Germany for years.

Health insurers must be given more rights allowing them to monitor mobile nursing services, Schirmer argues.

Gernot Kiefer, manager of the GKV national health insurance scheme, demands that the health insurance companies must be allowed to conduct unannounced spot checks rather than scheduled visits once every six months. "It's the only way to uncover such scams."

Media reports quote a confidential dossier from Germany's Federal Police (BKA) as saying the healthcare billing fraud by Russian care providers is "a nationwide phenomenon that affects in particular areas where close-knit, closed groups develop as a result of language barriers."

The BKA has declined to comment, but did concede that "municipal social assistance agencies and health and nursing care insurers, and therefore the general public, are suffering considerable damage," adding that the agency is on to the accounting fraud.

At the expense of the system

It's an outrageous public scandal to enrich oneself at the expense of the German welfare system and its contributors, says Christine Lambrecht of the Social Democratic Party's parliamentary group. Lambrecht urges a full investigation into the matter and punishment of those involved in the fraudulent billing.

Apart from better communication and allowing health insurance companies closer supervision, all of Germany's 16 federal states urgently need public prosecutors specialized in health care issues, Patient Rights Foundation CEO Brysch says. "It's appalling that care is now being named in the same breath as prostitution and drug trafficking."