Hospital specialists pocket millions through double-billing

4th November 2011, Comments 0 comments

Around five percent of medical invoices sent out by Dutch doctors and hospitals include double charges, enabling doctors to pocket millions of euros in extra income each year, according to claims made by a doctorate graduate of economics in Friday’s newspaper .

To complete her thesis at Maastricht University, Fleur Hasaart examined all the claims submitted to health insurer CZ between 2006 and 2008 and discovered evidence of outright fraud, as well as dubious ‘grey area' charges.

In total, hospitals and specialists earned one billion euros extra in that period, claims the researcher, who also works for CZ.

One procedure, two invoices Since 2005, medical invoicing at hospitals is done through a ‘packaging’ system which includes all the steps of treatment for an illness, from an X-ray to a check-up visit once the treatment has finished. But some doctors also bill for a visit separately. So an X-ray, for example, could be charged in the overall treatment ‘package’ invoice, as well as in a second single invoice.

“You can compare it to a painter who comes to paint a wall in your house,” says Hasaart. “You agree to a price for the whole job. If he paints two extra bricks, he doesn’t charge for them in a separate bill.”

There is also a large difference between hospitals, Ms Hasaart told de Volkskrant. In some hospitals, 90 percent of varicose vein operations form part of outpatient care, while in others the operation involve an overnight – with higher costs.

Lots of new hips Ms Hasaart cited other grey area examples - hip replacement operations are performed much more frequently than other procedures which generate less income. Or in hospitals with self-employed specialists, there were more expensive procedures carried out than in hospitals employing doctors with permanent contracts.

“Medical specialists are scarce. So, a health insurer can’t just force a large hospital not to offer them a contract. And the patient is generally more sympathetic towards the doctor than towards the insurer.”

The Dutch medical specialists' organisation OMS refuted all claims of fraud and pointed out it is the responsibility of health insurance companies to monitor the accuracy of bills. It concede that there were huge differences in the way hospitals register different treatments.

jn © Radio Netherlands Worldwide  

© Radio Netherlands Worldwide

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