Hi,

I had a lengthy consultation with a doctor (a specialist, not a GP) recently. It was very unproductive, no tests were made, no new treatment prescribed. Basically it was 50 minutes of me being distressed and the doctor declaring he can't help me.

Afterwards, I received an invoice which was clearly incorrect: it stated a particular kind of service was performed (it wasn't). I challenged that, and received another invoice, still mentioning another service that didn't take place. I suspect the doctor can't justify charging me for the full 50 minutes without making stuff up.

I wonder where I should report him for falsifying invoices? I thought about my insurance company, but since I'm still below my deductible, I doubt if they'd care. This is not about the money BTW, I just think the doctor shouldn't be able to get away with it.

Thanks,

natcam

Just tell the doctor that you don't mind paying the bill but that you want an invoice that reflects what actually happened. Otherwise just pay it and walk away, I don't think it is worth reporting anybody for, it will just become a major headache for you which you probably don't need.

You claim it took 50 minutes , why did you just not walk out if it was a waste of time? I guess the bill was about 250, what did you expect it to be?.

Thanks for replies.

@nigelr
I did tell the doctor once I want a correct invoice, got another incorrect one, I sort of think he had his chance.

@fatmanfilms
In the hindsight I should have walked out, but I didn't. Doesn't mean I should pay an incorrect invoice. Again, the money is not as important as the principle.

I'd still like to know what is the correct authority to report falsified invoices to.

natcam

Sorry you had a bad experience. I hope you manage to find a doctor who can help you.

According to this page (which is in French - I don't speak German I'm afraid), if you want to contest a medical bill you first of all contact the health professional who sent you the bill (which you have done). If you are not 'convinced', you should send the contested bill to your health insurance and ask them to check it. Finally, there are cantonal medical associations who provide mediation.

Google translate, polished by me:

Hope that helps.

I assume no witnesses?
It will be your word against his - who do you think will be believed?


p.s. A neighbour of mine just got billed 2,500CHF by a hospital for looking at his broken nose; he was told it is a standard fixed charge regardless of the work done. Which in his case was practically no work; as is usual with broken noses.

Just my two rappen here...Did you specify what you expected to see on the second bill? I think before you start making accusations as serious as falsification, it would be best to be clear on what you do expect to be on the bill and give him a chance to respond to those expectations.

@vlh22

Thanks a lot, this was exactly what I was looking for.

I appreciate others' input as well.

Best wishes

natcam

The simplest invoice would be:

1 x 00.0010 Konsultation, erste 5 Min. (Grundkonsultation)
8 x 00.0020 + Konsultation, jede weiteren 5 Min. (Konsultationszuschlag)
1 x 00.0030 + Konsultation, letzte 5 Min. (Konsultationszuschlag)

Total cost should be CHF 168.72

Just like the 15 minute simple consultation example from the Aerztekasse.

He may beef it up with some 00.0140. Ärztliche Leistung in Abwesenheit des Patienten (inkl. Aktenstudium), pro 5 Min.

But there are many other more options, see them all here http://onb.tarmedsuisse.ch/

Indeed, but here's the root of the problem: only 2 units (10 minutes) of 00.0020 can be invoiced per session. That's why he's has to make stuff up to charge for the full 50.

"Diese Limitierung entfällt für elektronisch abrechnende Fachärzte"
No limitation if he (or his billing provider) offers an electronic bill for the insurance. Nearly every doctor does, because there are too many such limitations in the TarMed. Your doctor must be a very wierd guy.

http://www.aerztekasse.ch/de/p12001598.html

For the very first time ever in my life, I complained to a doctor about his most recent bill....where he listed an examination he didn't do at all.



I wrote, as is my nature, a very nice and polite letter and asked them to explain why this examination is on the bill and send me please an updated bill.


Received the answer within a day....he'll waive the entire bill and asks me at the same time to look for another ENT now



I went for 22 years to his practice.....am stunned

Ask your local newspaper if they would be interested in the story.

I would inform the health insurance how your doctor acts. (what they do with it is up to them.)

East Enders, have you reported him yet. On the TSR news, a documentary on news about many doctors inflating bills, and insurances working hard currently to find them out, prove the fraud and make them repay. Some have had to repay huge sums. They say about 2% of doctors are guilty of above.

And those are only the ones that are found out.

I can imagine many bills are inflated to some extent or another. The hospital sends its bills directly to the insurance and they pay without question. I get copies of the amounts but never any description. Often it's many hundreds of francs with a "behandlung" date no where near any appointment. I guess it's for reviewing cases and planning but it often seems to be an awful lot.
A friend was once in for a UTI and the bill was 2000 CHF.


My last doctor's bill included two phone calls apparently made 3 days before the visit, which was a drop-in visit.

The main problem there is the Kontrahierungszwang. Swiss mandatory health insurers have to pay the bills of every accredited medical doctor/practice. The risk alone of being completely refused by the insurers (certainly they'd be likely to react mostly the same, perhaps even share their data and decisions) would definitely reduce the extent of these kinds of frauds.

In addition, falsely billed items could have negative consequences if they occur unusually often. At this time they're just removed from the bill so there's no risk involved for those who intentionally try to defraud the patients. A simple measure would be that the amount falsely demanded would be not just removed but actually subtracted from the bill once the number of false claims exceeds a certain threshold.

Maybe five years ago the latest try to have that requirement removed was undertaken by the Bundesrat, but they failed. The pressure by FMH, the Swiss doctor's association, was too intense. You have one try to guess why that would be.

You make me laugh...........only 2 %