“Serious omissions” in reports: Controversial company received 26 million francs from IV offices

PMEDA AG, led by doctor Henning Mast (70), has declared in the past that a large number of people are healthy, thus saving insurance companies millions of dollars in payments.

This is now over, at least as far as disability insurance is concerned: the responsible Federal Social Insurance Agency (BSV) announced this week that Canton IV offices will no longer be allowed to commission PMEDA to carry out medical reports in the future. hence in line with the recommendation of the Federal Commission on Quality in medical evaluation.

Their assessment showed that the “vast majority” of PMEDA reports reviewed had “serious formal and substantive deficiencies.”

Federal government reacts only years later

But the federal government’s intervention came late. There have been indications for years that Mast and his doctors were operating in questionable ways. “Kassenrutsch” had already reported in 2018 that PMEDA destroyed the existence of a man “in a record-breaking 36 minutes.” An audio recording of the patient interview showed that the psychiatric report on which the pension was denied was erroneous.

SonntagsBlick also reported on the Zurich valuation company. For example, about the so-called flight doctors who own Mast and come from Germany to evaluate Swiss IV candidates, whose expertise is often in the interest of insurance companies.

However, BSV and Minister of Health Alain Berset (51) remained loyal to PMEDA until the end. Mast’s company received more orders than almost any other provider. SonntagsBlick’s research shows: From 2013 to 2022, PMEDA was allowed to issue approximately 2,500 medical reports for IV and received 26.7 million francs for them.

IV only unaffected

This is just the tip of the iceberg. Because PMEDA worked not only for IV but also for numerous daily sickness benefits and accident insurers. It is unknown how large the order volume is in these regions. However, industry insiders assume it is at least as high as IV.

When asked, the Swiss Insurance Association (SVV) said no figures were available. PMEDA also ignored all of SonntagsBlick’s questions despite multiple attempts to contact him.

Feedback from individual insurance companies suggests that many customers will follow IV’s example. For example, Groupe Mutuel, which has regularly relied on the controversial company in the past, said on request: “Due to BSV’s decision, we can no longer continue to work with PMEDA.”

No justice for the injured

Neurologist Mast and his company will likely be considered pariahs throughout the entire insurance industry as a result of IV’s decision. But this is of no use to the countless applicants who were denied pension due to the PMEDA report. IV application procedures that have been decided should not be reopened. “Statutory benefit decisions remain in force,” BSV said in a statement.

Inclusion Handicap, the umbrella organization of disabled organizations, has no understanding on this issue. “Affected people were left behind because they did not have the courage, energy and financial resources to defend themselves against the IV decision based on the PMEDA report,” criticizes Petra Kern, head of the social insurance department.

BSV counters that PMEDA reports are examined for usability and probative value (also by the cantonal courts and the Federal Court in appeal cases). “We therefore assume that legally binding decisions are made based on evidentiary reports,” a spokesman said.

The problem with this claim is that since judges are not doctors, they do not evaluate the quality of the reports from a medical perspective. Only the legality of the procedures was checked, not their content.