Potsdam: High reclaims for Berlin's practice community confirmed!

Potsdam: High reclaims for Berlin's practice community confirmed!

The State Social Court (LSG) Berlin-Brandenburg recently published an important judgment on practical management, which is important for many medical practices in the region. According to Ärzte Zeitung , doctors are not allowed to transfer each other too often if they work in a practice community. This judgment could have far -reaching consequences for the statutory health insurance, especially for practices that exceed the limits of the legal requirements.

The court found that frequent transfers between the partners of a group practice are considered abuse. One example is a Berlin practice community of two specialists for orthopedics and trauma surgery, which was targeted by the examination agency due to a high patient identity. This identified that the proportion of the same name was between 25 and over 50 percent during the reviews, which was suspicious.

honorary claims based on patient identity

The recovery is an amount of almost 71,000 euros for quarters I/2011 to III/2013. The practical management explained the high identity of the patients with their specializations and further training. However, this reasoning was considered inadequate by the court. In similar cases, as with a specialist in anesthesiology, a patient identity of over 20 percent has also led to the dismissal of fees, as ecovis

The LSG decided not to allow any revision, since no reasonable reasons for this (Az.: L 7 KA 5/23). This could indicate that there are harsh sanctions against such practices in order to protect the accounting integrity within the Association of Statutory Health Insurance Physicians (Käv).

review of the billing by the Käv

The Association of Statutory Health Insurance Physicians has the right to subsequently correctly corrected fees and, if necessary, to be reclaimed, such as the mdw tax advice . This recovery can take place within a period of four years and often affects the examination of billing for plausibility and legal.

The regulations stipulate that a share of identical patients of over 20 percent and for cross -specialist group practices of 30 percent are considered critical of the same group of specialist groups. These limit values ​​must be observed by all doctors in the practice community in order to avoid legal problems

These recent developments bring both challenges and opportunities for the medical landscape in Brandenburg. While some doctors may have to reclaim their fees, it also shows how important it is to adhere to the legal framework for practice management. The experts are called to take possible misunderstandings and their consequences seriously so that they have a good hand in the future and stay legally on the safe side.