Suche
Mein Konto
Potsdam: High demands for reimbursement for Berlin practice group confirmed!
Ruling of the LSG Potsdam on the practice group: Transfers between doctors are limited in order to avoid abuse and reimbursement of fees.
Potsdam: High demands for reimbursement for Berlin practice group confirmed!
The Berlin-Brandenburg State Social Court (LSG) recently published an important ruling on practice management, which is important for many medical practices in the region. Loud Doctors newspaper Doctors are not allowed to refer each other too often if they work in a group practice. This ruling could have far-reaching consequences for medical billing, especially for practices that exceed the limits of legal requirements.
The court found that frequent transfers between partners in a group practice are considered abuse. One example is a Berlin practice group made up of two specialists in orthopedics and trauma surgery, which was targeted by the auditing body because of a high level of patient identity. This identified that the proportion of patients with the same name during the reviews was between 25 and over 50 percent, which was suspicious.
Fee refunds based on patient identity
The reclaims amount to almost 71,000 euros for quarters I/2011 to III/2013. The practice management explained the high identity of the patients with their specializations and further training. However, this argument was deemed insufficient by the court. In similar cases, such as with a specialist in anesthesiology, a patient identity of over 20 percent also led to the withdrawal of fees, such as Ecovis reported.
The LSG decided not to allow an appeal because there were no justified reasons for this (ref.: L 7 KA 5/23). This could indicate that harsh sanctions are being imposed against such practices in order to maintain billing integrity within the Association of Statutory Health Insurance Physicians (KÄV).
Verification of invoices by KÄV
The Association of Statutory Health Insurance Physicians has the right to subsequently correct and, if necessary, reclaim fees that have already been paid out, as MDW tax advice explained. This reclaim can take place within a period of four years and often involves checking invoices for plausibility and legality.
The regulations stipulate that a proportion of identical patients of over 20 percent in practices with the same specialist group and 30 percent in practices across specialist groups is considered critical. These limits must be observed by all doctors in the practice group in order to avoid legal problems.
These recent developments bring both challenges and opportunities for the medical landscape in Brandenburg. While some doctors may need to reclaim their fees, it also shows how important it is to strictly adhere to the legal framework when running a practice. Experts are called upon to take possible misunderstandings and their consequences seriously so that they can have a good handle on things in the future and remain legally on the safe side.