German health insurer reports record fraud attempts

AOK Hessen, Germany's largest health insurer, is confronting an unprecedented surge in suspected fraud, with reports of misconduct climbing by 10% in 2024-25 to reach 1,232. The insurer's dedicated anti-fraud team noted that while the methods of deception, such as billing for "phantom services" or submitting duplicate invoices, remain largely unchanged, the sheer volume has escalated significantly.

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The fraud mechanics and offenses have hardly changed in recent years.

Long-term care and home nursing are particularly vulnerable to these schemes. The AOK Hessen highlighted a case where a caregiver, working for a nursing service, defrauded the system of 72,000 euros by billing for 33 instances of "preventive care" that were never provided. Her grandson, also employed by the same service, was implicated in the fraud. The caregiver received a suspended prison sentence and lost her job.

Another elaborate scheme involved a nationwide supplier of medical supplies. This company printed prescriptions with forged details, using a consistent printing style across numerous orders from distant practices to disguise the fraud. Investigators uncovered this by noticing the identical print patterns. The AOK Hessen is seeking to recover 857,000 euros from this supplier alone.

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Never before have there been so many indications of misconduct in the healthcare system as in the years 2024/25.

While AOK Hessen has seen a rise in reported incidents, other major insurers like Techniker Krankenkasse (TK) report a stable overall financial damage volume despite an increase in incoming tips. The AOK Hessen's "secured claims" for the 2024-25 period rose by 45% to approximately 4.8 million euros compared to the previous two years.

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This scam was discovered because a large number of prescriptions showed identical print patterns, even though they were issued by practices far apart.