Mutiger Trick – Krankenhäuser betrügen auf Kosten der Prämienzahler | Übersetzung + Quelle in Kommentaren

Not usually a fan of Blick, but the article is 90% the same as the Tagi or the printed edition of the St. Galler Tagblatt, which I read this Zmittag.

Here is the article from Tagi behind a paywall:

https://www.tagesanzeiger.ch/gesundheitskosten-abzocke-der-hirslanden-spitaeler-mit-rabatten-103676311663

Translated Blick Article:

>__Bold trick__

>__Hospitals cheat at the expense of premium payers__

>__Hospitals are making high profits through a trick. To do this, they are taking advantage of a change in the law that should actually save costs. The outsourcing of X-ray images abroad also raises questions. This is shown by new research.__

>__Inflated Bills at the Expense of Premium Payers__

>Healthcare premiums continue to climb yearly, and overall costs remain high. While the focus should be on saving, some Swiss hospitals are doing the opposite. According to a report by the Tages-Anzeiger, these hospitals have been issuing highly inflated bills for medical products to health insurers over the past few months, raking in significant profits.

>For instance, one hospital paid CHF 60 for a single balloon used to expand narrowed arteries but charged insurers almost CHF 1,500. In another case, a hospital billed CHF 17,000 for small implants that cost only CHF 1,462.

>__Legal Loophole Behind the Trick__

>This scheme exploits a legal amendment that was meant to reduce healthcare costs. The amendment requires that discounts hospitals or medical practices receive on their purchases be passed on to health insurers. To encourage aggressive price negotiations, hospitals and practices are allowed to retain up to 49% of these discounts in the outpatient sector, with the rest going to insurers.

>However, some hospitals have manipulated this rule. The trick lies in the pricing system of medical products, which is often opaque. There are two prices: the “list price,” set when a product first enters the market, and the lower “net price,” which decreases over time due to negotiations and technological advancements.

>Since the amendment, both the net price and the inflated list price are included on delivery slips. This creates the illusion of massive discounts, even though suppliers never actually charged the inflated list price.

>__Investigations Underway__

>The Tages-Anzeiger investigation identified the Hirslanden Group, which operates 17 hospitals in 10 cantons, as a significant user of this practice. When questioned, the Hirslanden Group stated that it had hired a law firm in early December to investigate potential errors in implementing discount regulations and billing practices.

>Health insurers, including CSS, have confirmed these practices. CSS reported that “some providers systematically use this principle.” Insurers have since terminated contracts tied to the discount regulation, effective at the end of the year.

>__Outsourcing X-ray Imaging Abroad__

>Hospitals are also profiting through the outsourcing of imaging services. Several private hospitals, including the Hirslanden Group, and radiology firms have outsourced CT, MRI, and X-ray imaging to cheaper providers abroad while charging Swiss rates for these services, according to CH Media.

>Although this practice is not illegal, the Swiss Federal Office of Public Health notes that no authority is explicitly responsible for regulating whether patients must be informed about their data being processed abroad. Consequently, there is no clear answer as to whether patients should be notified when their medical data leaves the country.