Fraud case by doctor in public health care in germany.
Attention: What can happen to you when you are Expat in Germany with public health care…
The article is based on a real customer case, details and names have been removed due to data protection.
Imagine you are new to Germany and don’t speak the language.
You work in a good job, earn your money and are a member of one of the statutory health insurance companies.
One weekend you don’t feel well – and you decide to go to hospital because you don’t know that statutory health insurance is based on the GP (General Practioner = Hausarzt) principle.
After two or more hours of waiting, the doctor in the hospital tells you that you are not an emergency and should go to your GP for a check-up on the next working day.
Since you don’t understand German, you start researching, but most doctors don’t accept new clients or speak English – eventually you pick one who speaks at least a little English, after a while you get your first appointment….
In the next 3 years you went to the dentist twice, had a cold once, got vaccinated against it and had Covid19 twice and a broken arm because of cricket – nothing serious and no complications.
In your fifth year, you decide to switch to private health insurance with guidance and support of your German Sherpa consultant. As you answer the health questions, you want to give the right answers about what happened when.
So you ask your statutory health insurance company for a status report on all treatments over the last few years…
And then you realize the following with great shock:
Your GP – the person you trust with your life and your secrets – has diagnosed you with a serious, life-threatening illness, which he (or she) has billed for:
– Caring for a patient with at least one life-altering chronic illness.
– Differential diagnostic clarification of psychosomatic illnesses (which you don’t have!)
– Verbal intervention for psychosomatic illnesses
– five further, completely arbitrary diagnoses taken out of context, some of them even on days on which you were demonstrably not in his practice rooms or did not call…
And to top it all off, he diagnoses the ICD code: Z73, which is described as “problems related to difficulties in coping with life”, which is synonymous with depression and burnout.
In the same breath (in the same appointment), he bills a consultation for information on organ donation.
By the way – the reason you were there that day was because you had a cold.
Why do some doctors do that?
Because of the limited budgets in the public healthcare system.
In order to make a few hundred euros more (within 3 years) on this one patient, the doctor ruined THIS PERSON’S FUTURE with a click of the mouse on the box for Z73.
This irresponsible use of ICD code Z73 may be good for the doctor, but it is a death blow to ALL FUTURE decisions for this client in terms of
– Private health insurance
– income protection, disability insurance and
– term life insurance
with all companies on the German market.
