Weaknesses in the system: how fraudsters abuse health insurance cards

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The fraudsters’ method is simple: several uninsured people use one health card together, for example to avoid the deductible. For example, for excessive medication purchases at various pharmacies. Or for so-called performance tourism. Patients travel from abroad and seek treatment from a doctor using a card from friends (or strangers).

The resulting medical bill is later disputed or even disputed by the cardholder. Consequence of the fraud: the invoices are cancelled, the practice and the health insurer are left with the costs.

Fraud usually goes unnoticed

Such abuses occur again and again, various Swiss health insurers confirm to Blick. However, the damage cannot be precisely quantified because it often goes unnoticed.

Health insurers’ hands are often tied. In individual cases, they attempt to intervene directly with errant service providers. Or they reject customer demands or demand refunds.

Center Councilor Andreas Meier (61) is also aware of cases in the media in which uninsured people received medical care from an external health insurer. Albeit because they work illegally in Switzerland and have no health insurance. Albeit because it is without paper. Or people who cannot or do not want to pay the deductible, the fixed amount that must be paid annually for treatment costs.

No clear identification possible

Meier therefore submitted a corresponding proposal during the last winter session together with Nicole Barandun (55), his colleague from the National Council of Zurich Center. The two want to know from the Federal Council how in the future it can be ensured that no one receives benefits from a third health insurer.

Meier complains, for example, that health cards do not contain a photo of the holder that allows clear identification. “If the identity of every patient were checked, it would be practically impossible for several people to use the same health insurance card,” says the centrist politician. He does not want to deny anyone medical help, but this cannot be done wrongly.

Card restrictions should be possible in the future

Health insurers have been trying to prevent this type of fraud for years. For example, the CSS advocated that an insurance card could be used to a limited extent in the short term or that it could be checked electronically. “We have already made efforts to this end and contacted the Federal Office for Public Health (BAG). Such solutions should become possible in the future,” says CSS.

When asked, the BAG explains that misuse of health insurance cards in general cannot be ruled out, but that it is not aware of such cases. For the Federal Office, the responsibilities are clear: “It is up to the service provider and the insurer to check the data on the health insurance cards.”

Source:Blick