Cash doesn't have to pay: Doctor can't make up a fee figure - German court rejects fake billing codes for health insurance claims
A German court has ruled that statutory health insurers do not have to cover treatments billed with invented codes. The decision came after a patient was denied reimbursement for immunoadsorption therapy. The case highlights the risks of using non-standard health billing practices in the healthcare system.
The dispute began when a patient sought reimbursement for immunoadsorption treatment. Her doctor had submitted an invoice with a billing code that did not exist in the official system. The Berlin Social Court initially rejected her claim, prompting an appeal.
The Berlin-Brandenburg State Social Court upheld the earlier ruling. Judges confirmed that insurers are not required to pay for treatments coded incorrectly or falsely. They stressed that doctors cannot create their own codes and expect public health funds to cover the costs.
Germany's statutory health insurance system allows patients to choose cost reimbursement. This means they pay upfront and later submit invoices for partial health coverage. However, the court clarified that this option does not apply when billing codes are fabricated or invalid.
The ruling reinforces strict health billing rules for statutory health insurance claims. Patients and doctors must now ensure all submitted codes match the official system. Without valid codes, reimbursement requests will continue to be denied.
