No. "Billing fraud" is a term used in practice, not a separate criminal offense. Under criminal law, the accusation is regularly prosecuted as fraud under Section 263 of the German Criminal Code (StGB).
Frequently, the issues involve allegations of services not being rendered or being rendered incorrectly (e.g., "phantom services," upcoding), violations of the obligation to provide services personally, status issues, incorrectly assessed or non-billable services, and violations of prohibitions on cooperation. The scenarios are diverse.
As a suspect, you are not obligated to comply with a police summons. Under no circumstances should you make a statement without first seeking legal advice.
Searches are usually conducted early in the morning and without prior notice. The aim is often to secure billing documents, patient records, and digital data. Do not make any statements regarding the matter and contact a criminal defense attorney immediately.
The penalty under Section 263 of the German Criminal Code (StGB) ranges from a fine to five years' imprisonment, and up to ten years in particularly serious cases. In addition, there may be confiscation of assets, a criminal ban on practicing a profession (Section 70 StGB), revocation of professional licensure, and claims for reimbursement from cost bearers.
Case law generally considers a loss of substantial financial value, and thus a particularly serious case, to exist when damages exceed €50,000 – based on the individual loss per victim. The amount of damages significantly influences the sentencing range and sentencing. However, damage calculations can be challenged – the specific calculation method and the underlying assumptions should always be scrutinized..
It depends on the individual case. In many proceedings, intent is the decisive point of attack: without proven intentional conduct, criminal liability for fraud is ruled out. The question of damages can also be relevant to the defense.
No. Professional consequences are possible, but they do not automatically result from criminal proceedings. Whether and which measures are threatened depends on the professional group, the specific accusation, and the outcome of the proceedings. A criminal disqualification from practicing a profession (§ 70 of the German Criminal Code) and official revocation of a professional license can also occur cumulatively.
The basic offense is subject to a five-year statute of limitations. In particularly serious cases (§ 263 para. 3 of the German Criminal Code), the statute of limitations is ten years. Whether the limitation period has already begun to run, has been interrupted, or whether multiple offenses are involved is a legal detail that must be examined on a case-by-case basis.
As soon as you become aware of an investigation – for example, through a summons, hearing, notice of an investigation, or search – you should seek legal counsel immediately. Do not make any statements about the matter without having reviewed the case file. The sooner a criminal defense attorney is involved, the greater the chances of controlling the proceedings and limiting professional and financial damage.