Despite its economic dominance in Europe, Germany, like many of its neighbours, suffers from a rapidly ageing population. It is estimated that one out of five German citizens today are aged sixty-five or older. This demographic has allowed for the rise of a lucrative healthcare sector with an economic output of 287.3 billion euros as of 2010, equivalent to approximately 11.6 per cent of Germany’s GDP. Yet a shortage of skilled care workers has forced the nation to turn to foreign care workers in order to meet the demand resulting from their population. Many of those care workers come from Eastern Europe, with a vast majority of those workers being of Russian descent. This has allowed for the penetration of outside forces into the German healthcare system and has created a loophole which, according to recent reports from German media, has allowed for Russian organised crime to abuse the generous healthcare system using a wide variety of methods linked to fraudulent billing scams and embezzlement. These reports come after German authorities uncovered financial losses of upwards of one billion euros annually within German nationalised healthcare companies, with the losses mostly stemming from fraudulent logbooks run by Russian mobile nursing services, in which these services often ‘[targeted] lucrative cases: patients requiring intensive care, running up bills of thousands of euros per month. Reportedly, such scams can garner the Russian services up to 15,000 euros per month.’

Image courtesy of calvinbasti, © 2008, some rights reserved.

Image courtesy of calvinbasti, © 2008, some rights reserved.

The way Germany’s universal multi-payer healthcare system works often makes it an easy target for criminal operations. Germany offers two types of insurance to all its citizens: basic insurance and long-term care insurance, without any added charge to the patient. In short, patients can seek almost any type of health care they wish, whenever they wish. The fervently expanding residential care sector is imperative in formulating a response to the rapidly ageing demographic’s needs. However, good methods of communication between authorities regulating basic insurance and long-term care insurance are relatively non-existent. This lack of communication has been recognised by Germany’s nationalised insurance companies who have pushed the German Parliament, the Bundestag, for increased healthcare insurer rights, allowing for increased oversight in regards to mobile nursing units. Dominik Schrimer of the Bavarian branch of AOK, a health insurance company, commented to DW his frustration with the current system, arguing that these scams have been occurring systematically across Germany for years already, adding greater oversight is ‘the only way to uncover such scams’.

Eugen Brysch, the CEO of the German Foundation for Patient Rights, has also been a long-term advocate for stricter controls of at-home care. He has stated that often, health care professionals charge the patient’s insurance company for twenty-four hour health care, although they would only check on the patient a few times throughout the day, or they would charge for services never rendered. Or, sometimes, family members would be accomplices in the fraud, taking a cut of the insurance payouts. A majority of such cases do revolve around patients needing intensive health care, of which there are nearly nineteen thousand German citizens. The cost of providing medical care to these patients runs at an average of 22,000 euros per month, with new estimations that one-fifth of this money on average is lost to fraudulent activities. At a recent press conference, Germany’s federal police released a statement saying, ‘The healthcare invoice fraud by Russian care providers is a nationwide phenomenon that affects particular places where there are groups that are closed off by language barriers. In some cases, Russian-Eurasian organised crime is known to have invested in home care services.’

One of these places happens to be in the German capital, Berlin, where authorities cracked down in a series of raids on suspected billing scams, arresting dozens mostly of Eurasian descent and Russian nationality this past April. Over one hundred police officers raided thirty locations around Berlin, most notably arresting the manager of a major German healthcare company suspected of embezzling upwards of one million euros along with seven employees of the same company and thirty-one of the company’s patients. The main scam in this particular case revolved around requesting unnecessary medical services for healthy people that the company would fast track through insurance providers. Nurses and patients would then share the insurance payout. According to authorities, the company charged an average of 2,000 euros per month per patient faking these logs. The Berlin Interior minister released a statement after, calling the raids ‘a powerful blow against organised nursing fraud’.

German legislators have recognised the need to strengthen the system against abuses. The German Bundestag adopted 14 April a proposed bill called ‘Combating Corruption in the Health Sector’, allowing for more stringent healthcare checks by insurance providers and extending criminal sentences for those complicit in healthcare fraud, adding such activity to Germany’s anti-corruption legislature. Christine Lambrecht of the Social Democratic Party’s parliamentary group called for continued investigations into the matter, stating, ‘it’s appalling that care is now being named in the same breath as prostitution and drug trafficking’. This move shows the Bundestag’s commitment to eliminating healthcare fraud, and the electorate’s desire for such activity to be monitored more heavily. While the bill is not yet enforceable, it is expected to come into power later in the year, and in the meanwhile be a heavy deterrent against fraud, with the resolution promising, ‘criminal liability… where a healthcare professional in relation to his occupation… allows himself to be promised or accepts a benefit for himself or another for according unfair preference in domestic or international competition when prescribing or procuring pharmaceutical products or when introducing patients. Vice versa, those who offer, promise or grant a benefit to healthcare professionals under these circumstances will be criminally liable’.

While change looks to be on the horizon in regards to medical fraud, these scams may reflect deeper issues of abuse plaguing Germany’s institutions as the country struggles to deal with its ageing demographic. The future for Germany’s healthcare system remains uncertain, however, perhaps new legislation and continuing police crackdowns on scams will play into a solution