Exclusive
Status: 08/17/2022 5:59 p.m
A draft bill from the Ministry of Health caused a shake of the head: Since the associations of statutory health insurance physicians refuse to check corona tests for fraud, the minister now wants to transfer the task to the RKI.
The outcry was great when in May 2021 research by NDR, WDR and “Süddeutsche Zeitung” revealed cases of fraud worth millions in several corona test centers. The then Health Minister Jens Spahn stated that he wanted to fight the fraud. When Karl Lauterbach took over the Ministry of Health at the end of 2021, there was still no concept for the fight against the alleged mass fraud in Corona rapid test centers. Lauterbach announced at the end of June that the fraud should finally be over.
But the Minister of Health was caught off guard – by the Associations of Statutory Health Insurance Physicians (KVen). The organizations, which are mainly there to distribute health insurance money to resident doctors in every federal state, were previously tasked with checking the billing for the rapid tests and have now declared that they no longer want to do this in the future.
“Due to past experience, we cannot trust that all test centers will provide the services correctly,” wrote the board members of the KVen in a joint letter to Lauterbach. Therefore, in the future, one cannot “responsible for making payments with one eye on bills whose correctness we cannot begin to check”.
Ministry of Health draft bill
Lauterbach then said in discussions that the Robert Koch Institute (RKI) should then do the audit. Those involved waited in vain for six weeks for a plan of how this should look in concrete terms. It was not until Tuesday evening that the Ministry of Health sent a draft bill to those involved NDR, WDR and “Süddeutsche Zeitung”.
According to this, the RKI should analyze the accounting data in the future, identify “statistical outliers”, check the reasons for a free test as well as the positive rate of the quick tests. If the RKI discovers irregularities, it should inform the local health authorities and the responsible Association of Statutory Health Insurance Physicians, according to the ministry’s plan.
RKI is bound by instructions
The RKI is a scientific authority whose task is to identify and combat infectious diseases. The institute has never had to deal with billing fraud. However, the RKI reports to the Ministry of Health. It is bound by instructions and cannot refuse orders from Lauterbach.
The RKI press office officially announces that it has “expertise in statistics and mathematics” and can discover anomalies. Underhand, however, one hears that the idea of being responsible for testing rapid test operators is an “air number” – one has neither the resources nor the technical knowledge for it.
No further funds for the RKI
The draft from Lauterbach states that the RKI incurs costs “of an unquantifiable amount” for the audit, but the RKI should not receive any money for the new task. Ministry spokesman Andreas Deffner said on request: “Financial compensation is not planned.” This is surprising, because the health insurance companies have received a flat rate of 2.5 percent of the billing amount for each corona test since May, before it was even 3.5 percent.
Since the citizen tests have cost the state around twelve billion euros so far, around 400 million euros flowed to the health insurance companies for payment and control alone. Even if they are no longer supposed to check the citizen tests in the future, they should still receive the flat rate of 2.5 percent. “There are no plans to change the administrative cost rates of the associations of statutory health insurance physicians,” said Lauterbach’s ministry.
Those involved now have until August 22 to comment on the draft bill.
“I can already see the fax machines glowing”
At the Berlin State Criminal Police Office, Jörg Engelhard heads a commissariat that deals almost exclusively with billing fraud in corona tests. He now estimates the damage caused by fraudulent citizen tests nationwide at more than one billion euros. The investigator considers the planned new regulation from the Ministry of Health to be of little use.
“The RKI should give the local health department information if data is conspicuous. But then the health department would have to carry out a tangible check and, for example, request the addresses of those tested,” says Engelhard. “I can already see the fax machines glowing.” For him it is incomprehensible why the task of auditing accounts is transferred to an institute like the RKI, which has no experience with it.
In addition, it is unclear who will take care of the probably many millions of fictitious tests from the past. “This is about billions in tax waste, which has so far only been insufficiently processed.”
Engelhard also thinks it is a wrong signal that the KVs are released from the task of examining, but should continue to receive the same remuneration as we have been so far. “That seems to me like a gift to the KVs and is not logical in itself, because the question inevitably arises as to how valuable the test has been if the same money is paid in future without a test.”
KVen have stopped payments in many places for the time being
The National Association of Statutory Health Insurance Physicians (KBV) itself already fears being held liable for failure to carry out billing checks. The public prosecutor’s office in Berlin is currently examining whether the board of directors of the local Association of Statutory Health Insurance Physicians may have made themselves liable to prosecution for breach of trust because they checked the accounts too laxly or not at all.
In many places, health insurance companies have currently stopped paying the amounts to the rapid test centers and are waiting for the new regulation. While up to one billion euros per month have been transferred to the rapid test centers in recent months, according to the latest figures, it was only 152 million euros last month.