25.04.2024 – 13:48
caseQuo GmbH
Hannover (ots)
Dear Minister Lauterbach,
We are deeply concerned about the draft bill for the law to improve the quality of care in hospitals and to reform remuneration structures (KHVVG). The planned abolition of the individual case audit of hospital bills and the planned introduction of a sample audit instead have considerable political and social explosive power: they are tantamount to an invitation to hospitals to make false bills. The result: significant financial losses for the statutory health insurance companies – the National Association of Statutory Health Insurance Funds, based on careful projections of previous incorrect billings, assumes three-digit million amounts annually – and further rising contributions for the insured.
As already described in the past, the restriction of billing audits that took place around 4 years ago (unprecedented in legal and business transactions for good reason) harbors the risk of systematic incorrect billing. A complete abolition of individual case controls would further increase the imbalance in the system between revenue-oriented service provision and economic use of resources instead of creating a balance.
Just imagine, for example, that car repair shops or plumbing specialists work like this: inspect the damage, carry out repairs without a prior offer, then issue an invoice at your discretion and have the money transferred without any further explanation. Consumers are only allowed to check their bills on a random basis. Perhaps the craft businesses, for example, would have to explain and justify 5 percent of all invoices. 19 out of 20 companies could therefore expect to provide services as they wish and, above all, to bill them as they wish. If the inspection reveals an inflated invoice (e.g. because services not provided are billed or services provided are over-invoiced), the craft business does not risk more than a small fine. Although many people would certainly behave in solidarity, work correctly and bill properly – don’t you also think that a surprising number of brake pads or seals would be on the bill, that oil changes would often be “necessary” very early on or that taps would be surprisingly often “worn out”? This means for the GKV system: If each hospital bill is overcharged by (only) EUR 200 on average, the unauthorized sum to be paid by the GKV amounts to more than EUR 3.36 for over 16.8 million hospital cases (2022 according to Destatis). Billions every year!
Conclusion: A sample check is far from sufficient to record the error rate and potential misuse in billing. By abolishing systematic review, you risk millions of euros in contribution money being carelessly wasted and important resources for urgently needed medical services and fair health care for the population being lost.
As a working group that specializes in checking hospital bills for statutory health insurance companies and works not for profit, we know exactly the pitfalls of this system. We experience first-hand the concerns of health insurance managers about ever-increasing hospital costs. Expenditure on inpatient cases already accounts for around a third of statutory health insurance service expenditure and has been rising significantly for years. The consequences are devastating – for the health insurance companies, for the statutory health insurance system and, above all, for the citizens’ wallets. casusQuo therefore fully agrees with the argumentation paper of the BKK umbrella association dated April 12, 2024.
What also causes us great concern is that the systematic case-by-case assessment with which the health insurance funds fulfill their legal mandate to use funds economically does not only serve to protect contributors from unnecessary costs and mismanagement. It also helps maintain trust in our healthcare system. By weakening this important oversight body, you risk undermining citizens’ trust in the integrity and transparency of health administration.
We urge you to listen to those who face the consequences of incorrect billing every day:
Hans-Walter Schneider, board member of BKK Pfalz: “If in future we are no longer allowed to check in individual cases whether the hospital has actually provided the billed service, this will lead to a competitive disadvantage for hospitals that have always delivered good quality. The restriction of Examination of performance does not fit at all with a law that aims to improve the quality of care in hospitals.”
Thomas Johannwille, CEO of Bertelsmann BKK: “As BKK, we have always had close ties to our sponsoring company. We are therefore concerned about the expected increases in contributions. Because in times of economic stagnation, rising non-wage labor costs are an additional burden for all companies.”
Nicole Müller-Coonan, board member of BKK Mahle: “In our role as an “advocate for the insured”, we want good, not just expensive, medical care for our insured people. We are obliged to manage and use the contributions in a fiduciary manner. Treatments that are not necessary We would like to prevent this in the spirit of solidarity.”
Frank Heine, board member of energie-BKK: “The replacement of the previous individual case audits of hospital bills with new sample audits is a risky experiment far from reality. Experience and results show that without an efficient individual case audit, the GKV will incur additional expenses relevant to the contribution rate, which will be borne by the community of insured persons in addition are to be worn.”
Tobias Mittmann, board member of BKK24: “As BKK, economic activity is part of our DNA. If the individual case assessment is no longer carried out, we will be deprived of an essential tool for this work. With a view to the development of contributions, this cannot be in the interest of health policy!”
Wolfgang Allgaier, board member of BKK Scheufelen: “I don’t know of any other business where invoices are generally paid without being checked. This reduces the cost-effectiveness requirement anchored in the Social Security Code to absurdity.”
Harri Ackermann, CEO of BKK Deutsche Bank: “Many health insurance companies have already planned their budgets very tightly for the current year. The federal government certainly cannot have any interest in skyrocketing health insurance contributions from 2025!”
Dear Minister Lauterbach, stop the abolition of the individual case review before it is too late!
With urgent appeal and kind regards
Udo Halwe
Managing Director of casusQuo GmbH
Kontakt CasusQuo GmbH
Elke Lütkemeier (Head of Marketing)
Email: [email protected]
Phone: 0511-93644-241
www.casusQuo.de
Original content from: casusQuo GmbH, transmitted by news aktuell