German hospital demands EUR 430,000 after 12 lawsuits

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The Health Insurance Fund (HIF) keeps incomplete records of claims for advances for treatment abroad, which creates a risk of additional costs for conducting legal proceedings with foreign hospitals, the State Auditor determined in the audit of the Fund’s operations for 2022.
In the case of invoices received from foreign hospitals with a higher amount than the advance payment, they are recorded in the Fund’s business books up to the level of the advance payment, without taking into account the actual invoiced value of the services provided. The Fund justifies this with the fact that the insured did not submit requests for the additional costs.
Such case cost the Fund 430,000 euros after 12 lawsuits from a German hospital brought during 2021 and 2022, for payment of costs for treatments made in the period from 2017 to 2019 above the amount of advances given and for which in the Fund’s business books the debt is not recorded. For some of the claims, judgments have been passed by the German court with which the Fund is responsible for paying the costs of treatment. To make the tragedy worse, the same hospital owed the Fund a refund of 116,000 euros for higher advance payments for the previous years, which the Fund did not know about, and determined by checking the records.

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