A judgment of the District Court (AG) Neu-Ulm dated June 26, 2024 (ref.: 2 Ls 106 Js 10145/22) deals with a case of fraud and forgery by a doctor who billed for services over a long period of time without properly maintaining the necessary medical documentation. He was charged with a total of seven counts of fraud and five counts of falsifying evidence.
Facts
The defendant worked as a general practitioner and ran several practices. Between 2019 and 2020, he billed the Bavarian Association of Statutory Health Insurance Physicians (KVB) for services in accordance with the fee schedule for psychosomatics (GOP 35100) in several quarterly statements. He deliberately untruthfully assured that the services were properly documented, even though in many cases this was not the case.
The investigations revealed that in a total of 7,016 cases the defendant had billed for services that were not supported by appropriate documentation. The resulting damage to KVB amounted to 96,357.14 euros.
Legal situation
The defendant pleaded guilty to fraud § 263 StGB and falsification of evidence-relevant data § 269 StGB made punishable. Due to the extent of the fraudulent billing, each case was considered to be a particularly serious case of fraud, which resulted in a penalty range of six months to ten years in prison.
Sentencing
The court imposed a total prison sentence of one year and three months on the defendant. His comprehensive confession and compensation for the damage were taken into account in mitigating the sentence. The defendant appeared remorseful and had already settled the entire damage by offsetting other accounts. However, the duration of the offenses and the high level of damage had a more severe effect on the punishment.
The prison sentence was suspended because the defendant had not previously committed any criminal offenses and the court assumed that he would not commit any further crimes.
Conclusion
The ruling by the AG Neu-Ulm underlines the importance of proper documentation for medical services. Even seemingly small irregularities in billing can have serious criminal consequences, especially if they are committed systematically over a longer period of time.
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