The key to the doctor’s fee

The key to the doctor's fee

One trial, two cases: on the one hand, the case against a coburg family doctor is about billing fraud; on the other hand, the 62-year-old physician is alleged to have had sexual relations with two women, even though he was treating them psychotherapeutically. That is why he is accused of sexual abuse – he exploited the doctor-patient relationship.

On tuesday, the only issue before the criminal division of the coburg district court was billing fraud. For this reason, anna grebner, from the public prosecutor’s office for economic crimes in hof, came to represent the prosecution. But the investigation was conducted in coburg, and not for the first time, as a police chief inspector testified: "he was a regular customer in the fraud squad", she said about the defendant, who has already been sentenced twice to custodial sentences. In one case, he had billed services for a patient who was in prison during the period in question. The health insurance was not responsible, but the man received free medical care.

In the other case, the doctor had treated patients under the so-called general practitioner model and received the general practitioner’s flat rate from the AOK for this. Despite this, the doctor had billed the association of panel doctors for services that were actually already covered by the general practitioner’s flat rate. This case was tried in the spring of 2015; the doctor received a custodial sentence at that time. The policewoman said that she had investigated other cases against the man; however, she did not know what the outcome of these cases would be.

"It’s rare to see such dedicated officials who are almost tunnel-visioned on an accused", commented defense attorney johann schwenn. The policewoman was not the only witness whose statements he critically questioned. A doctor who had wanted to buy the coburg GP practice in the spring of 2016 was subjected to a cross-examination by him.

The purchase agreement had already been signed and provided that the defendant would continue to practice as an employee and that his successor would take over the billing. But because the young doctor did not come to the 1. April 2016, the defendant cancelled the sale of the flat. A little later his practice burned down. According to her own statements, the doctor now had doubts as to whether all the information on the sales of the practice was correct. On the advice of her legal protection insurance, she went to the police. "I didn’t want to get involved in anything", she said.

According to police records, in 2016 the doctor had expressed clear doubts that the fire could have been set by a burglar who was after narcotics. In court, the doctor now testified that the officers had asked her what she thought of the matter. The second police officer, who was investigating the fire and, according to the doctor, was present during the interview, is not mentioned in the report. "Protocols must normally be true", commented lawyer schwenn.

KVB demanded reimbursement

The key number is 01436. It is included in the doctors’ fee statements for the "consultation fee", which amounted to 1.82 euros in 2015. From july 2013 to april 2015, the doctor claimed this flat rate 27386 times – wrongly, as the indictment states. Since the beginning of 2008, not only the key number for the consultation fee has changed, but also the definition of the fee. "Fur 01436 must have a referral slip.", said a witness, who is responsible for the examination of accounts at the kassenarztliche vereinigung bayern (KVB) (association of panel doctors in bavaria). Previously, under the old system, the consultation fee was allowed for each patient contact.

As early as 2012, an internal audit by the KVB concluded that the defendant had used the new key number incorrectly, i.E. Without a referral from the patient. The witness cited the relevant note in the file and also said that the defendant was not the only one to have made this mistake. For this reason, the KVB once again pointed out the correct use of the key number in its monthly circular in september 2015.

The KVB audited the physician’s accounts at the request of the arbeitsgemeinschaft der krankenkassenverbande in bayern (working group of health insurance associations in bavaria). This request came in october 2013; the audit began in the fall of 2016. The witness reported that he noticed that the key number in question was used more frequently than average and incorrectly. The audit had revealed other irregularities. For this reason, in june 2017, KVB demanded the return of overpaid fees from the years 2013 to the beginning of 2015 from the defendant; this amounted to around 63,000 euros due to the incorrectly used key number 01436 alone.

In february 2017, the investigation into accounting fraud was already underway. Police searched the doctor’s practice at the time. At the hearing next tuesday, the doctor’s employees will be heard on both the fraud and sexual abuse allegations.

Like this post? Please share to your friends:
Leave a Reply

;-) :| :x :twisted: :smile: :shock: :sad: :roll: :razz: :oops: :o :mrgreen: :lol: :idea: :grin: :evil: :cry: :cool: :arrow: :???: :?: :!: