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Rising malpractice in healthcare: Complex cases are on the rise
Find out more about the increase in misconduct in the healthcare system and the measures taken by the investigative team at AOK Rheinland/Hamburg. Damage of 4.87 million euros uncovered! #Health care #Fraud #AOK #Investigation team
Rising malpractice in healthcare: Complex cases are on the rise
The investigation team at AOK Rheinland/Hamburg has recorded a worrying increase in misconduct in the healthcare system, with the cases becoming increasingly complex. Between 2022 and 2023, the health insurance fund suffered a total loss of around 4.87 million euros due to fraudulent behavior and corruption. The severity of the financial damage caused by these crimes places a considerable burden on those insured and those paying contributions.
The AOK Rheinland/Hamburg activity report reveals that a total of 1,485 cases of misconduct were prosecuted in 2022 and 2023. During the reporting period, new cases increased to 669, while 816 existing cases from the previous period remained under investigation or were the subject of ongoing criminal proceedings. This represents a worrying increase compared to 2020/2021, in which 590 new cases and 823 existing cases were recorded.
The service areas of medicines and bandages as well as home nursing were particularly affected, causing damage amounting to around 3.46 million euros and 1.01 million euros, respectively. Perpetrators range from individuals to third parties seeking to profit improperly through counterfeit prescriptions or improper care. In order to counteract this form of economic crime, representatives of the AOK Rheinland/Hamburg advocate the use of specialized police and judicial units as well as more intensive cooperation between social security providers and authorities.
Simone Lötzer, the misconduct officer at AOK Rheinland/Hamburg, together with other experts, is calling for reliable scientific studies in order to find out the true extent of these crimes and to be able to combat them appropriately. In addition, the need to adapt data protection is emphasized in order to facilitate the exchange of information between social security institutions and to improve investigative work.
Since 2004, health and nursing care insurance companies have been legally obliged to set up bodies to combat misconduct in the healthcare system. Since 2021, AOK Rheinland/Hamburg has been offering an encrypted whistleblower channel that enables anonymous reports. These measures are intended to help increase trust in the healthcare system and limit the damage caused by fraudulent behavior.