Corona citizen tests: windfall for associations of statutory health insurance physicians

The Association of Statutory Health Insurance Physicians received 350 million euros for the billing control of rapid tests. After research by NDR, WDR and SZ, at least the KV in Lower Saxony uses the money for other purposes.

Nationwide, the state has so far spent around twelve billion euros on citizen tests. According to the test regulation from the Ministry of Health, the associations of statutory health insurance physicians should pay out the money to the test centers and check whether the statements are plausible. The KVs are allowed to keep 2.5 percent for this work, until May it was even 3.5 percent. In this way, the medical organizations nationwide have so far received around 350 million euros.

In Lower Saxony, the Association of Statutory Health Insurance Physicians (KV) admits that it has generated enormous surpluses by billing for citizen tests. “The legislature made 30 million available to us,” says KV spokesman Detlef Haffke, but “we never asked for this sum.”

Subsidies far in excess of what is needed?

The state payments are apparently so generous that there are enormous surpluses, at least in Lower Saxony. In any case, when asked, KV Lower Saxony admits that it employed 25 people to carry out the tests last year.

If you very generously estimate wages and ancillary costs of EUR 100,000 per year for each employee, the KV has not spent more than EUR 3 million – but at the same time it has collected EUR 30 million in administration fees. “I can’t answer whether that’s too much,” says KV spokesman Haffke. “But we will not refund the money.” The surpluses were “parked” in a sensible way in order to promote doctor’s offices in rural regions.

Information partially denied

The other associations of statutory health insurance physicians in Germany are very reticent when asked how much surplus they have achieved with the citizen test flat rates. The KV Baden-Württemberg writes “that we do not give any opinion on this”. The KV North Rhine takes the position that the flat rates are “used to finance the infrastructure of the KV”. And the National Association of Statutory Health Insurance Physicians writes in addition: “Even after the expiry of the test regulation, the Associations of Statutory Health Insurance Physicians will have to continue to carry out accounting audits to a not inconsiderable extent.”

Despite the enormous sums that the KVs receive for billing control, there is apparently massive fraud with the tests. Several hundred preliminary investigations are being conducted nationwide against test site operators. Investigators from the Berlin State Criminal Police Office estimate the damage caused by bogus bills or overpriced test kits nationwide at more than one billion euros.

First public prosecutor investigates

According to the budget politician of the Greens, Paula Piechotta, the associations of statutory health insurance physicians “failed to monitor them”. Therefore, one must now examine “to what extent the KVs can be held liable for the failure to check fraud in the quick tests, because this has caused immense damage to the taxpayers”. In Berlin, the public prosecutor’s office is already examining investigations into the local KV board members for possible infidelity.

Large capacity mini test center

In Buxtehude, Lower Saxony, you can see how poorly the on-site control works. So the KV according to information from NDR, WDR and “Süddeutsche Zeitung” (SZ) blocked payments to a test center in November 2021 due to inconsistencies. The operator is said to have moved his test site by 50 meters and set up a 1.5 by two meter box.

It remains unclear whether the local health department checked them on site. However, it has attested to the amazing capacity of this mini test center of 1000 to 1400 tests per day. The KV resumed payments – without having looked at the situation on site. Around 400 tests per day were billed up to March.

Procedure no longer understandable

The health department in Stade explains that “according to the documents” it was never informed by the KV about the payment freeze. However, the office does not seem to be 100 percent sure and states: “Due to two changes in personnel in the specialist area, unfortunately I cannot provide you with any further information on this at short notice”.

The fact that hardly any positive cases were discovered in the affected test station also doesn’t seem to have bothered anyone. While around 3.3 percent of all citizen tests in the entire Stade district from October 2021 to March 2022 were positive, it was only 0.6 percent at the Buxtehude test center.

Positions assign responsibility to each other

However, the authorities are apparently still used to shifting responsibility back and forth. The Stade Health Department writes: “The billing and its verification is the sole responsibility of the Association of Statutory Health Insurance Physicians.” The KV contradicts: “This statement is wrong. We are not a supervisory authority that works on site. That is the task of the health authorities.”

The operator of the Buxtehude test station himself does not want to answer any questions: he writes by email that investigations are now underway against him, so “I do not want to comment on the facts in public”. and adds: “Of course, I am always ready to prove the plausibility of my statements to the responsible authorities, especially the KVN.”

Other test centers in the Stade district, which also report an unusually large number of tests and very low positive rates, explain the situation with employees who did not work correctly or say that they combined several test stations when submitting their numbers.

Hardly any suspected cases in Lower Saxony

The Association of Statutory Health Insurance Physicians in Lower Saxony says that they reported a total of ten test stations to the public prosecutor as suspected cases. Ten of around 4000 rapid test operators registered in Lower Saxony.

According to a controversial plan by Health Minister Lauterbach, the Robert Koch Institute is to join the rapid test control in the future, but unlike the KVs, it should not receive any money for it. Instead, the lump sums should continue to flow to the KVen at the previous level, as confirmed by Lauterbach’s Ministry of Health on request.

Even the KV is a little irritated by this generosity. Spokesman Haffke considers the plan to be “a flaw in the law”. He put it politely: “I don’t know if the lawyers in the Ministry of Health have really thought through a new strategy. But what’s happening at the moment is really strange.”