At least CHF 20 million in damage: BAG hunts for fraudulent doctors

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In April of this year, reader Adriana Meier, who actually has a different name, received a statement from her health insurer for 47 francs for a Covid test. Only: she had never done such a test before, the name of the doctor was completely unknown to her. The Reichmuth family, who also declined to be called by their real names, experienced something similar. Here the bill was even richer: their health insurance company paid the doctor 329 francs for tests he had never performed.

Like these doctors, several medical professionals also took advantage of the exceptional situation during the pandemic to illegally supplement their income – at the expense of health insurance premiums and taxpayers. The Federal Office of Health (FOPH) states that the amount of damage currently known and allegedly fraudulently settled is at least CHF 20 million. This is only the preliminary status, the BAG is currently processing about 40 other abuse files. Only after these investigations have been completed can the final damage amount be determined.

According to the BAG, doctors allegedly charged the service “medical flat rate for detailed doctor-patient conversation” in several cases without justification. That alone caused damage of eleven million francs. Another scam involved doctors making their pay agency registration number (ZSR number) available to other people, such as test center operators, and charging money for it.

The ZSR number is a condition for claiming through the compulsory health insurance. The mere transfer – but not the financial compensation demanded for it – took place with the blessing of the BAG, which wanted to enable an offensive testing strategy. A mistake, as the agency itself admits today after criticism from the Swiss Federal Audit Office.

“Criminal action” initiated

So far (as of June 2023), the FOPH has already recovered CHF 19 million in illegally withdrawn funds. In addition, payments of an estimated 30 million francs have been stopped so far. “We attach importance to the fact that a very large number of service providers have correctly invoiced the covid tests carried out,” said spokeswoman Gabriela Giacometti. In total, the federal government assumed costs of three billion francs for more than 23 million Covid 19 tests in the years 2020 to 2022.

What now threatens the fallible doctors? The BAG says that “criminal action” has been taken. But “because of the confidentiality of the investigation” they would not say which ones they are. In September last year, the agency replied at the request of parliament that no criminal report had yet been filed.

Source:Blick