Germany battles care home fraud after mafia scandal

Germany is casting around for ideas on how to deal with large-scale fraud in its care industry, after a leaked police report last month sent the issue flashing across the media landscape again.

The internal federal police report showed that Russian health care services - possibly with links to organized crime - were systematically defrauding public and private health insurers of at least 1 billion euros ($1.1 billion) a year, mainly by claiming they had carried out services they had in fact not rendered.

On Tuesday the German foundation for patient protection (DSP) presented a new eight-point plan to fight the crime as part of a "long overdue public discussion" on care fraud in Germany, as a statement put it.

"We would be making it difficult for swindlers to swindle," DSP CEO Eugen Brysch told DW. "Wherever organized crime operates, it's never good for the quality of care - that's a contradiction - and it's always at the expense of patients."

"But it's not just about patients, but also about those services that do good work," he added. "If there are no rules that everyone can stick to, then the good services will be the losers, and that would be wrong."

Uniquely exploitable

Many of the DSP's eight ideas seem fairly straightforward - they include increasing quality controls, setting up specialized police units, and standardizing procedures across Germany's 16 states, which are subject to different nursing home procedures. Point 5, meanwhile, calls for the creation of online sites where people can report wrongdoing anonymously.

The DSP argues that Germany's health insurance system is uniquely susceptible to fraud, mainly because of unnecessary bureaucratic complications introduced by the government and health insurers over the past decades.

Unlike other European countries, Germany makes a distinction between health insurance and care insurance - a separation that was made over 20 years ago. "These two services stand alongside each other, even though they serve one and the same person - the patient, who has to have two different insurance policies," said Brysch. "And fraudsters know how to make money from this jungle, because there is no transparency over where and why people are getting certain services. That model exists nowhere else in Europe."

A key difference between health insurance and care insurance in Germany is that while health insurers generally cover costs in their entirety, patients have to pay for part of their care themselves. This, according to Brysch, also provides fertile ground for criminal gangs. "With some skillful maneuvering between the full-payment and part-payment systems and some poor quality service, a fraudster can earn a lot of money," he said. That is one of the reasons why the DSP is calling for Germany's systems to be unified, so that patients have one number for both insurances.

Some complaints

But not everyone was particularly enthused by the new attention given to the issue and the DSP's proposals. "There are some good ideas, but the cases that were uncovered now were uncovered under the current system," said Olaf Bentlage, spokesman for the association of private social care providers (BPA).

Bentlage is not sure the current system is that broken, and he worries that extra regulations will only be counterproductive. He was not particularly enamored of the DSP's proposal to digitalize all records of services, so that data would be more traceable, for instance. "At the moment, let's say it says, 'washed in the morning,' then there has to be a check mark and a signature," he explained. "And then you can see fairly easily if something has been manipulated - you check the type of pen used, or if the handwriting has changed. But if you do that electronically, then someone only has to press a button."

"People with criminal energy always find ways, and means, especially with organized crime," he added. "And we're warning against bringing in extra controls, because in Germany that always means double and triple bureaucracy - and we're currently in the middle of a very successful de-bureaucratization campaign."

Slow government

Brysch, meanwhile, argues that successive governments have stalled on the issue, and let it get out of hand. "We've been discussing fraud with various health ministers for over ten years," said Brysch. "Up to now, every one of them has sat it out. Clearly, the population isn't satisfied with that,and wants a good solution."

"If [Health Minister Hermann] Gröhe doesn't act, then this issue could become part of the election campaign, and then he certainly will act," he added. "If the minister has no answer to the question 'How will our politicians prevent fraud?' then it will become a problem for him in the election year."

For its part, the health ministry said it is already drawing up a whole slew of anti-fraud measures, and pointed to a conference it held at the end of April with representatives of the police forces and medical industry associations.

"There was unity that the care-improving laws and other laws for newly-introduced control powers [...] are important to effectively prevent fraud," the ministry said in a statement emailed to DW. The ministry also said that a standardized screening process for nursing home companies would be introduced in 2017 and has already been tested in several German states.