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According to research by the NDR apparently guided to inflate invoices. For lawyers, this can be an incitement to fraud.
A short greeting and then we get started. In an online seminar, the participating doctors should learn how they can “charge a lot more” for private patients – as Kaweh Schayan-Araghi puts it at one point. He is co-founder and medical director of the Artemis Eye Clinics, one of the largest medical chains in Germany, and sits on the board of the Professional Association of Ophthalmologists (BVA). He held the seminar last fall together with a billing expert from his company.
It’s about a lot of money. Tens of thousands of private patients probably come to Artemis. With the support of financial investors, Schayan-Araghi and his colleagues have created a large company – with more than 100 locations and around 2,000 employees, including more than 300 doctors. And they are apparently supposed to ensure that income increases. This is what research shows NDR.
Increases are only permitted in exceptional cases
Schayan-Araghi and the Artemis billing expert provide information on several examinations and treatments in the seminar. For example, they ask doctors to describe every operation for cataracts as particularly complex. One would like the doctors to “always find a reason with which we can charge the maximum rate” – that is around 250 euros more than usual. According to the law, such an increase is only permitted in exceptional cases and must therefore be justified.
“Even though you might not think it’s that difficult, you have to be a little creative,” explains Schayan-Araghi. To support this, there is a “comprehensive collection of various reasons for improvement” in which doctors can “browse a bit”. “Step up!” the medical director calls on the employed doctors. “This is our way of getting a little bit of inflation compensation.”
Schayan-Araghi also has a special note about retinal surgery. There are two different billing figures for them, he explains. With one you would get 1,000 euros more. Actually, this higher yield number is intended for more complex procedures and for a special method called “humpback surgery”.
“We know we hardly do that anymore,” says Schayan-Araghi. But the doctors are apparently supposed to include the word “hump” in the surgical report. Because the inspectors at the insurance companies would pay attention to this. That’s why doctors should refer to an indentation that is briefly made during each of these surgeries as a “temporary hump.” “Then the accountant sees the magic word ‘hump’ and doesn’t remove the 1,000 euros,” says the medical director.
“Earn money quickly”
The seminar also covers a number of smaller amounts for various investigations. Around 16 euros for an eye test, which should always be done on private patients. This is “quick money earned,” says Schayan-Araghi. This is unfair, “but if it happens to be unfair in our favor, then we would like to take advantage of it.”
A doctor who works at Artemis but wants to remain anonymous reports in an interview with ARD-Magazine panorama, he and his colleagues almost all had to take part in such accounting training. From his point of view, the aim was to “drive up private bills”. In the seminar they were given some questionable advice – for example, that they should always do this eye test for 16 euros on all private patients.
“It’s like when you go to the ENT doctor because your nose is running, and they do a hearing test every time,” he says. They also learned that they could easily charge more than 20 euros “if we shine a flashlight in their eye for a moment.” According to the Association of Private Health Insurance Companies, this pupil reaction test is actually part of a flat rate for an eye examination. But with Artemis he is apparently charged extra.
Violation of professional regulations?
This is “training to maximize profits,” says medical lawyer Andreas Spickhoff from the Ludwig Maximilians University (LMU) in Munich panorama-Interview. “This is not an exhaustion of the fee schedule, but rather an overstimulation.” The seminar leader and the participating doctors who followed such instructions would be violating professional regulations and could lose their license to practice medicine.
The lawyer even sees parts of the training as a possible incitement to commit a crime. If this was actually how the billing was done, it would have to be “qualified as gang-related fraud” due to the large number of doctors involved, says Spickhoff. “And as a fraud that led to particularly high damage.”
It is a “huge mess” that “an unbelievable amount of money” is made in this way, says the former head of the public prosecutor’s office for billing fraud in Schleswig-Holstein, Dorothea Röhl. She also sees the seminar as a possible incitement to billing fraud. But proving a crime is “incredibly difficult.” Ultimately, courts would have to examine each individual billing.
Call for stronger controls
From their point of view, private health insurance companies should have greater control, as should the state aid agencies, which take over part of the billing for civil servants who are generally privately insured. “They should notice,” says Röhl, if, for example, all surgeries in a practice were billed at the highest rate.
The aid office in Hesse, where Artemis is headquartered, didn’t want to deal with that NDR speak. She said in writing that she would investigate suspected cases and was currently developing “automated testing regulations”. When asked whether it had happened in recent years that a large medical chain had systematically billed higher amounts, she did not give a specific answer.
Several large insurance companies did not answer this question either, only writing in general terms that they would check invoices for any abnormalities and, in serious cases, involve investigative authorities.
It remains unclear whether Artemis doctors actually write above-average bills or whether they do not or only partially follow the instructions from their headquarters – and also how other large medical chains handle it.
Kaweh Schayan-Araghi himself could possibly provide information. He has been a member of the board of the Professional Association of Ophthalmologists (BVA) for many years and is the first chairman of the Federal Association of Eye Surgeons (BDOC). However, he did not respond to a request for an interview.
The company firmly rejects the allegations
In response to written questions, his company Artemis said it firmly rejected the allegations. “The Artemis Group acts in accordance with applicable laws.” All doctors are obliged to adhere to the fee schedule. The Artemis Group “fully follows all applicable billing regulations at all times, including the GOÄ”.
Your own compliance guidelines state “unambiguously” that “treatment services provided must be documented correctly.” And according to Artemis, doctors decide how to treat patients for medical reasons alone. “When selecting the respective treatment method, the most efficient and effective method for the best possible patient care always and without exception comes first,” says Artemis.
You can see more about this and other topics on Panorama – today at 9:45 p.m. on Erste and in the ARD media library.