Berlin Court Convicts Two in Decade-Long Health Insurance Fraud Scheme
Berlin (dpa/bb) – A former board member of Berlin's Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung, or KV Berlin) has been sentenced to ten months in prison, suspended, for accepting bribes. A co-defendant, an employee of a statutory health insurance fund, received a €15,000 fine for bribery. Over a decade ago, the two men allegedly made illegal agreements, though the court ruled they had not personally profited. Instead, payments were directed to the KV.
According to the court, the defendants retroactively altered coded medical diagnoses without consulting the treating physicians, manipulating data to secure higher allocations from the health fund. The scheme involved records from 2015, while additional allegations concerning 2014 were not substantiated. A third defendant—a health insurance employee—was acquitted.
Defense: "Correcting faulty data"
The court found that the defendants were aware their actions violated regulations, including those of their own oversight bodies. For the 62-year-old former KV board member, the scheme had been a "welcome opportunity to improve the association's financial situation" while also doing a favor for the insurance fund. The 46-year-old insurance employee saw it as a chance to advance his career, the court said, adding that he had "succumbed to the incentive and pressure." He was fined 150 daily rates of €100 each.
At the trial's outset seven months ago, defense attorneys dismissed the charges, calling corruption allegations "far-fetched." They argued that the case had never involved falsifying accurate data—only "correcting erroneous entries."
Prosecution: Excessive payouts
Investigators allege that the former KV board member received data storage devices from the two co-defendants and authorized the changes, enabling the insurance fund to obtain inflated payments. "As a result, these funds were not distributed to other insurers under the morbidity-adjusted risk equalization system," prosecutors stated. The case initially centered on around €85 million in wrongfully disbursed funds.
The court imposed lighter penalties than those sought by prosecutors, who had requested suspended sentences of up to one year and nine months, along with a €250,000 forfeiture from KV Berlin. Defense lawyers had pushed for acquittal. The ruling is not yet final.
