Tuesday, October 11, 2016

Health insurance: allegations of fraud of TK-in-chief for Zoff t-online.de

The allegations of TK CEO Jens Baas in the “Frankfurter Allgemeine Sonntagszeitung” (FAS) against other health insurance companies are making waves in the health care system and in politics. Baas had said that the cashier tried to get over doing this with the Doctors more money.

Baas accused, especially the regional funds, without naming names. – were meant to be but obviously the General local sickness funds (AOK). This is now particularly intense. Baas just wanted to be a Modification of the financial rules for the funds, so that TK could in the future offer a lower additional rate of contribution in health insurance competition, said army chief Martin Litsch.

The German Foundation for patient protection turned to its own information, a criminal complaint against the TK and other health insurance companies in the Hamburg public Prosecutor’s office. Possible criminal liability for serious fraud, the Executive Board Eugen Brysch said.

the municipal hospitals accused the health insurance companies the systematic accounting fraud and demand immediate investigation by the Prosecutor’s office. Obviously, the funds used annually in contribution funding of several hundred million euros, “to secure unwarranted payments”, – said the Deputy Chairman of the Association of municipal hospitals, Susann Breßlein. This is not a minor offense, but could shake the confidence of the Insured in the seriousness of the cost object.

patient on paper sicker had said,

Baas: “It’s a competition between the sickness funds is created, who creates it, to bring Doctors to document for the patients as many of the diagnoses.” Then there is more money from the risk structure compensation. There are premiums for Doctors, the patients on the paper sicker.

The leading Association of the Statutory health insurance (Shi) is now calling for more transparency in medical diagnoses in order to avoid manipulation. The Doctors boycotted “practices, the introduction of mandatory coding guidelines in the doctor,” said Shi spokesman Florian Lanz, the “Passauer Neue Presse”.

as a result of unclear standards for determining the Severity of a disease, the diagnoses are only comparable to a limited extent and manipulations possible, said Lanz. Exact diagnoses were for the equitable distribution of the money from the joint Contribution Fund of the health insurance is very important, said Lanz.

Over the risk-structure compensation (RSA) in support of statutory health insurance funds with a total of healthier members to those with relatively many “patients at risk”, for example, the chronically ill.

attempt at Reform ever

The Shi head Association failed, complaining that it had given in the last term, is already a draft binding guidelines for the uniform coding of diagnoses. So the Doctors had to make their findings transparent. The scheme had been cancelled under pressure from the doctors but from the law.

The health policy spokeswoman of the SPD parliamentary group, Hilde Mattheis, requested that the Supervisory authorities of the Federation and the länder to clarify the allegations of the TK-heads “quickly and consistently”. The financial compensation needed to make clear coding guidelines are less prone to manipulation.

The requested non-governmental organization Transparency International, that the contracts between health insurance funds and Doctors will be made in a Register open to the public. In addition, the Supervisory authorities of the Federation and the länder would have to be reformed structurally, since they were able to check the coffers sufficiently.

the chief of The doctors Association of the Hartmann Bund, Klaus Reinhardt, appealed to discuss the kassenärztliche bundesvereinigung, and the Shi, “with open visor”, as the Disincentives could be eliminated from the risk structure compensation.

the Essen-based health economist Jürgen Wasem calls for consequences. “The Supervisory authorities of the insurance companies are responsible, and need to uncover violations of the consistently and keep track of,” said Wasem, the “Ruhr Nachrichten”. He spoke of a “legal grey zone” and demanded “clear and nationally uniform assessment standards”. To make patients on the paper sicker, “is prohibited and a criminal”.

estimator decide on the next additional contribution

this week, the estimated circle comes along for the statutory funds. On Thursday, then to determine how much of the additional contribution for the funds are available in the coming year, in the cut, so the insurance companies can pay for their services.

deviations from the average up or down can threaten a cashier in the competition or to the front. The risk structure compensation scheme plays an important role.


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