[Billing fraud from the viewpoint of the federal health insurance society].
During the past ten years, there has been a controversy among the German registered physician about settlement fraud-then outraged, now calling for criminal proceedings and an investigation by the public prosecutor. This is due to the fierce competition in a system of dense medical representation. Economically, any settlement fraud in the compulsory health insurance damages the colleagues, not the health insurance. An assessment of remuneration settlements under criminal law reveals the following: there is only one premeditated, punishable settlement fraud. Before demanding criminal proceedings which result in investigations by the public prosecutor, the society of panel doctors has to decide whether there is a case of premeditation or negligence. The society must be aware of the consequences for the physician. Types of deficit settlement: (1) settlement of services not rendered; (2) settlement of services not rendered personally; (3) false settlement of services rendered; (4) uneconomical settlement of services. Whether the latter can lead to criminal investigation, is still controversial. Within the medical profession, however, disciplinary action as well as proceedings for the cancellation of the licence can be requested.
Richter-Reichhelm
M
M
Kassenärztliche Vereinigung, Berlin.
D005251:Fees, Medical / Q000331:legislation & jurisprudence*; D005607:Fraud / Q000331:legislation & jurisprudence*; D005858:Germany; D006801:Humans; D009313:National Health Programs / Q000331:legislation & jurisprudence*