Pharmacist cheats health insurance company with wrong prescriptions – Bavaria

The defense attorney interrupts his speech and briefly apologizes to the accused next to him, he doesn’t have to say anything flattering. “Actually,” he explains and looks at the woman he is representing on Monday before the seventh criminal chamber at the Augsburg Regional Court, “it was done so stupidly that sooner or later it had to be noticed.” The pharmacist cheated her health insurance company by almost 520,000 euros with forged prescriptions for a very expensive psoriasis drug, which she issued without his knowledge with a false signature via her husband, a dentist. The 53-year-old confessed to everything in court, and the presiding judge sentenced her to three years in prison.

The public prosecutor emphasizes that it is an “unusual case” that a pharmacist cheats with prescriptions that are issued to her. At the same time, the procedure highlights cases of fraud in the healthcare sector. The prosecutor criticizes that the accused took advantage of the health care system, which is based on trust, which is why the process is also an example of a phenomenon that is now causing so much financial damage that the Free State has set up its own central office to combat fraud and corruption in the health care system, in short ZKG, fought.

The investigators – also in the case of the pharmacist and her shop in Neu-Ulm – are based at the public prosecutor’s office in Nuremberg. Since it was founded in September 2020, the ZKG has initiated 568 new procedures and completed hundreds of old procedures. The complicated healthcare system invites fraud, warned the senior public prosecutor Richard Findl, Bavaria’s top investigator in the healthcare industry, recently in a November balance sheet. The dark field is large. If you take a British study as a benchmark, the damage in Germany due to fraud in the healthcare system would be more than 30 billion euros a year.

If you act “cleverly”, Findl also said in November in the case of the pharmacist accused in Augsburg – and is therefore in agreement with her defense attorney – such fraud in the existing billing system is usually not even noticeable. At the health insurance company, however, employees were suspicious that a dentist was issuing prescriptions for psoriasis. The 53-year-old prescribed 108 injections for herself in 2019 and 2020, with blank prescriptions and stamps from her husband’s practice. Such a syringe of the drug Stelara costs almost 5,000 euros.

According to her own statement, the woman actually suffers from psoriasis, but she has hardly used the drug. Instead, she took the money from her health insurance company and apparently kept her head above water. She had already gone bankrupt with a pharmacy, but she reopened a shop in Neu-Ulm, which has since closed, and probably used the income from the fraud to pay off her debts and pay her employees. Her defense attorney emphasizes that she did not live in luxury.

The woman returned her medical license of her own accord

An employee of the health insurance company said during the process that it was not possible for insurers to check all regulations. The public prosecutor recapitulated in her plea that payments are made relatively quickly so that the health system can run. “That’s why the health insurance companies trust that everyone will meet their obligations.” However, there are currently particularly frequent suspected cases of fraud in corona tests, every third procedure of the ZKG plays in this field. Many investigations – most of which are based on fraud at the ZKG – are also directed against doctors, ten percent each against physiotherapists and nursing services.

“You abused the trust of society and the health insurance companies,” the presiding judge reprimanded the accused in his verdict. A sentence that could be suspended would therefore have been “the wrong sign”. Nevertheless, the court’s sentence of three years in prison falls far short of the demand of the prosecutor, who had considered four years and six months to be reasonable. The court recognizes, among other things, that the pharmacist confessed early and in full and has since paid back more than half of the damage. She also recognized herself that she was “not capable of character” to run a pharmacy, which is why she forestalled a professional ban and returned her license to practice medicine. A judgment by the Neu-Ulm district court from the summer is also included in the prison sentence: the 53-year-old has already been sentenced there for illegally selling prescription painkillers.

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