Billing Fraud in Berlin's Healthcare Sector: Majority of Police Investigations Target Home Care Services

The Berlin State Criminal Police Office is currently compiling data on financial damages caused by fraudulent activities within the city's healthcare sector over the past year. Preliminary findings indicate that the majority of investigations focus on billing fraud associated with ambulatory care services, highlighting a persistent issue within the sector.

According to the police, approximately 175 cases of billing fraud have been recorded so far, with final figures for the year anticipated to exceed 200, similar to previous years. These cases encompass a range of healthcare providers, including hospitals, care homes, pharmacies, and notably, outpatient care services.

Widespread Issues in Ambulatory Care

Analysis reveals that more than 60 percent of all fraud investigations pertain to ambulatory care providers. Physicians account for an additional 15 percent of cases, a third of which are linked to clinics. Comparable numbers of investigations also concern pharmacists, medical supply stores, hearing aid specialists, and opticians. Furthermore, around ten percent of cases from 2025 involve fraudulent operators of COVID-19 testing centers.

Billing fraud typically involves submitting inflated or entirely fabricated claims to statutory and private health insurers, and in rare cases, directly to patients. The German healthcare sector, with an annual turnover exceeding 500 billion euros, remains particularly vulnerable to exploitation due to its size and complexity.

Common Methods of Healthcare Billing Fraud

Instances of fraud often include billing for non-existent diagnoses and treatments or exaggerating the severity and complexity of legitimate medical interventions. In ambulatory care, it is not uncommon for providers to employ lower-paid, unqualified staff in roles that require certified professionals, thereby reducing staffing costs while billing at higher rates.

One recurring scheme involves recruiting seniors who are instructed on how to convincingly present themselves as needing care to insurance assessors. If successful, the insurance provider assigns a care level to the individual, resulting in monthly payments amounting to several thousand euros per patient, which are then improperly claimed by the care service.

Financial Impact and Ongoing Enforcement

Efforts to combat billing fraud are ongoing, with the police and regulatory authorities working to identify offenders and recover financial losses. The continued prevalence of these cases underscores the importance of robust oversight and transparent billing practices within the healthcare sector.

The findings highlight the need for increased vigilance across healthcare providers, insurers, and patients alike. As the authorities finalize annual damage assessments, further details about the scope and impact of these fraudulent activities are expected to be released.