Since billing systems do not automatically chronicle pre-existing conditions for patients, health insurance companies have been receiving money for treatments that may not have taken place, according to ARD’s investigative news show Plusminus.
In addition to this glitch, the software also does not automatically test data for plausibility, mistakes or manipulation, the show said.
Healthcare economist Stefan Sell estimates that the recently centralised government fund to finance the country’s statutory insurers may have paid out up to €10 billion due to the software errors.
Such data errors include a code in the billing system for ophthalmologists that automatically indicates a new HIV infection. In the first quarter of this year – not long after the healthcare fund began on January 1 – there were several thousand cases where the code was used unnecessarily. Experts told the show this probably cost some €160 million, though it has recently been corrected.
Sell said there were likely 2.5 million such coding mistakes each quarter in the billing software that could be minimised by the addition of a plausibility test.
The Federal Insurance Office could technically request that insurance companies return the money, but it’s not likely to happen, the show said.
“The damages are within limit,” a spokesperson told the show. “Because all of the insurers have profited, it’s a zero-sum game.”