{"id":1170,"date":"2026-04-13T16:19:44","date_gmt":"2026-04-13T14:19:44","guid":{"rendered":"https:\/\/galen.de\/?page_id=1170"},"modified":"2026-06-03T09:49:45","modified_gmt":"2026-06-03T07:49:45","slug":"billing-fraud-in-the-healthcare-sector","status":"publish","type":"page","link":"https:\/\/galen.de\/en\/rechtsgebiete\/wirtschaftsstrafrecht\/medizinstrafrecht\/abrechnungsbetrugs-im-gesundheitswesen\/","title":{"rendered":"Healthcare billing fraud"},"content":{"rendered":"
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Criminal defense in cases of healthcare billing fraud<\/b><\/h2>

A summons as a suspect, a search warrant for your practice, an inquiry from the Association of Statutory Health Insurance Physicians \u2013 the accusation of billing fraud usually hits doctors, dentists, pharmacists, nursing facilities and therapists suddenly and with considerable force.<\/span><\/p>

Under criminal law, this allegation is generally prosecuted as fraud under Section 263 of the German Criminal Code (StGB) \u2013 an offense with complex requirements regarding deception, error, and harm. Particularly in the healthcare sector, it is crucial to understand that billing errors alone do not constitute a criminal offense. Whether criminal conduct has occurred depends largely on whether the billing complied with the relevant regulations and whether intentional misconduct can be proven.<\/span><\/p>

Both of these often present a challenging question of proof \u2013 and this is precisely where effective criminal defense comes into play.<\/span><\/p>

When is<\/b> a <\/b>Is there billing fraud in the healthcare sector?<\/b><\/h2>

Under criminal law, "billing fraud" is not a separate offense, but rather a term used in practice. Prosecution typically occurs under the fraud offense defined in Section 263 of the German Criminal Code (StGB).<\/span><\/p>

The legal definition \u2013 in simplified terms \u2013 requires:\u00a0<\/span><\/p>

  1. a deception about facts <\/span>(explicitly or implicitly)<\/span><\/li>
  2. an error caused by this <\/span>at the recipient<\/span><\/li>
  3. a disposition of assets due to error\u00a0<\/span><\/li>
  4. a financial loss\u00a0<\/span><\/li>
  5. Intent with regard to all objective characteristics and the intention to obtain an unlawful financial advantage for oneself or a third party.<\/span><\/li><\/ol>


    In the healthcare sector, this is particularly relevant: Even submitting an invoice can be considered implied fraud. The service provider thereby implicitly declares that the billing requirements are met \u2013 even if they do not explicitly confirm this.<\/span><\/p>

    The damages are determined according to social security law standards: The decisive factor is whether a claim for payment existed under the relevant social security regulations. If this was lacking \u2013 for example, because a service was not properly provided or was not billable \u2013 the sum paid out is considered the damages.<\/span><\/p>

    The relevant billing regulations include: <\/span>The Uniform Assessment Scale (EBM), the Fee Schedule for Physicians (GO\u00c4), the Fee Schedule for Dentists (GOZ), and, in the inpatient sector, the DRG system. Errors or questions of interpretation in these regulations frequently form the basis for criminal charges.<\/span><\/p>

    Typical scenarios in healthcare billing fraud<\/b><\/h2>

    The suspicion of billing fraud can be directed in particular against: doctors, dentists, psychotherapists, employees of hospitals, pharmacies, medical supply stores, physiotherapy and therapeutic practices, as well as nursing and care services.<\/span><\/p>

    Typical case groups are:<\/span><\/p>