Prohibited influence of health insurance on Physicians

Improper coding advice: health insurance companies influence on Doctors

Although the influence of medical diagnoses is prohibited by statutory health insurance, Doctors continue to be proposals for coding of diagnoses. This is evident from the data in a new study.

Fraud and corruption

Corruption and fraud in health care is not really new. For example, it was reported in the past, pharmaceutical companies paid a half a billion euros to Doctors and studies. In addition, it was already known years ago that health insurance companies Doctors pushing to multiple diagnoses in order to get more money. And now a study has made it clear that statutory health insurance funds continue to exercise illegal influence on physicians.

Measures have been declared by the legislators to be inadmissible

Still improper coding advice found in offices of Physicians, instead of – although this Form of the influence of health insurance companies is prohibited by the legislature for a long time.

As a recent study by the TIG 2 Institute on behalf of the techniker Krankenkasse (TK) is shown reported nearly one in five respondents physicians (19.4 percent) since January of 2018, of such measures.

According to a communication from the TK 40 per cent of the affected respondents of the representative survey of personal coding advice, 31.7 percent reported by telephone coding advice, 36.7 per cent of influence on the practice software and 19.2 percent over Nachkodierungen in the framework of the performance audit by the health insurance companies.

Actually, it should be their goal, to examine whether the prescribed services are “adequate, expedient and economical” in the sense of the social code – not, however, to use this to Nachkodierung for the purposes of the funds.

The information, according to any of the above measures by the legislator, at the latest, with the healing and tools-supply-strengthening act (HHVG) in April 2017 inadmissible.

12.5 percent of the Affected also reported to have coding advice on other measures (multiple answers were possible).

Several doctors have declared to be with the patient lists and relevant coding recommendations supplied.

Another result of the survey: More than half of the respondents (55 percent) don’t like such a coding recommendations.

Every fifth physician reported of coding influence

“That one in five medical coding interference is reported, shows that the financial balance of the funds will need a proper manipulation of the brake,” says Dr. Jens Baas, Chairman of the Board of TK.

“The current draft of the Shi-FKG provides for meaningful action. The attack only if they are implemented as a total package. It is crucial to introduce a unified supervision of all the funds.“

The legal provisions are interpreted by the different Supervisory authorities continue to vary widely.

Therefore, the current draft law of the Federal Minister of health, Jens Spahn also provides for a uniform supervision for all funds, which welcomes the TK explicitly.

According to the opinion of the TIG 2 Institute &#8211 comes; as well as the legislators – to the following conclusion:

“Under the present conditions of the different regional and national Supervisory practices, it is the AAS not possible, even under the stricter legal environment of healing and AIDS care act, the influence of health insurance companies to Doctors to stop.”

And further: “Therefore, it is appropriate, by the Federal Ministry of health (BMG) with the draft intended goal, to finish these parallel structures in favour of a single instance in a timely manner.”

Competition distorting differences to compensate for

The on 25. March from the Federal Ministry of health submitted draft of the “Fair cash choice act” (GKV-FKG) provides for, among other things, the introduction of a full model, the future is to take into account all the diagnoses for the financial compensation, as well as the introduction of a regional component.

This is to compensate for regional competition distorting differences. Additionally, a number of measures to stop the interference in the encoding of diagnoses.

“The bill is a clear message in terms of manipulation, the evidence of a profound knowledge of the problems. This useful will be diluted in a complete package now, the Manipulation in a new round,“ said Baas.

Additional surcharges for the funds

According to the diseases surveyed, the theme of the coding advice were called 65 percent of the respondents diseases of the cardiovascular system, 49 percent Endocrine, nutritional, and metabolic diseases.

These areas include the assignment of relevant diagnoses “hypertension” and “Diabetes”, which will trigger additional surcharges for the funds, for example:

In the case of hypertension, there are 251 euros more per year for a 45 Year old Insured, the insurance company gets compared to a healthy person of the same age.

In the case of a simple Form of Diabetes, there are 384 euros. For both diagnoses, the case numbers have increased significantly in recent years. (ad)