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Every second health insurance company tricks on illnesses

Every second health insurance company tricks on illnesses

Federal Insurance Office criticizes health insurance companies for cheating on illnesses of their insured

The Federal Insurance Office criticizes numerous health insurance companies, which apparently cheat heavily when it comes to information about the illnesses of their insured. This emerges from a report of the newspaper "Rheinische Post". Accordingly, the experts discovered abnormalities in almost every second health insurance company. According to a newspaper, a BKK reported an increase in heart attacks of 280 percent. Since the amount that the health insurance funds receive from the health fund depends on the age and health of their members, the statistical cheating about serious illnesses is financially worthwhile for the insurers.

59 of 134 health insurance funds are said to have cheated in statistics for serious illnesses. As the newspaper reports, there is an urgent suspicion that numerous health insurance companies knowingly cheat in statistics for serious illnesses such as heart attacks. The Federal Insurance Office is therefore targeting many health insurers. The authority discovered abnormalities in 59 of a total of 134 health insurance companies. The authority is now demanding a declaration from the insurer. For example, a health insurance company reported that there was a 280 percent increase in heart attacks among its insured. However, the number has only increased by less than one percent for all health insurers. The Federal Insurance Office rated the information provided by another insurer, according to which the number of skin ulcers had increased by 30 percent, in a similarly implausible manner. Overall, however, the number for this clinical picture only increased by 1.5 percent in the entire POS system.

According to the newspaper, the detailed tests were carried out at company health insurance companies, an IKK, an AOK and a replacement fund. The affected insurers face financial sanctions if they fail to explain the above-average numbers for some illnesses plausibly. For example, the Federal Insurance Office could initiate financial cuts for the health fund funds. The amount of money that the individual health insurance companies receive from the health fund depends on the age and health of the insured. Thus, the cheating of the serious illnesses is worth it for the health insurers - the more serious illnesses occur among the insured, the more money is paid out.

Funds criticized for savings in pension provision Recently, the funds were criticized for significant savings in pension provision. As the "Spiegel" reported last week, the statutory health insurance companies are said to have reduced spending on health promotion and anti-stress measures by around 30 percent between 2008 and 2012. According to the news magazine, this corresponds to an amount of EUR 3.41 per insured person, which is only slightly above the statutory value of EUR 2.94. Above all, there have been cuts in the so-called individual measures such as spinal gymnastics or burnout prevention. According to the prevention law planned by the federal government, however, more money should actually be spent on health care.

In addition, the health insurers are increasingly trying to send sick leave workers back to their workplaces. According to Federal Minister of Health Daniel Bahr (FDP), it is understandable that the health insurance funds have to check the sick leave, but sick leave should never be rejected in general, in bulk or after only a short inspection of the file. "The individual case must always be considered and an individual decision made", Bahr told the "world". (ag)

Image: Dieter Schütz / pixelio.de

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