{"id":1170,"date":"2026-04-13T16:19:44","date_gmt":"2026-04-13T14:19:44","guid":{"rendered":"https:\/\/galen.de\/?page_id=1170"},"modified":"2026-04-28T12:36:48","modified_gmt":"2026-04-28T10:36:48","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":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"1170\" class=\"elementor elementor-1170\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6acff9f e-flex e-con-boxed e-con e-child\" data-id=\"6acff9f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b14b524 red-underline elementor-widget elementor-widget-text-editor\" data-id=\"b14b524\" data-element_type=\"widget\" data-e-type=\"widget\" data-no-translation=\"\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t<style>.elementor-element-b14b524{display:none !important}<\/style>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-90a7900 elementor-widget elementor-widget-button\" data-id=\"90a7900\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/galen.de\/en\/#kontakt\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Contact<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-6d4964c e-flex e-con-boxed e-con e-parent\" data-id=\"6d4964c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ff3870e red-underline elementor-widget elementor-widget-text-editor\" data-id=\"ff3870e\" data-element_type=\"widget\" data-e-type=\"widget\" data-no-translation=\"\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t<style>.elementor-element-ff3870e{display:none !important}<\/style>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-430f437 uael-faq-box-layout-yes align-at-left elementor-widget elementor-widget-uael-faq\" data-id=\"430f437\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"uael-faq.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n\t\t\t<div id='uael-faq-wrapper-703' class=\"uael-faq-wrapper\">\n\t\t\t\t<div class=\"uael-faq-container uael-faq-layout-accordion\" data-layout=\"accordion\" >\n\t\t\t\t\t\t\t\t\t\t\t\t<div id=\"uael-accordion-6b79aef\" class=\"uael-faq-accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t\t<div class= \"uael-accordion-title\" aria-expanded=\"false\" role=\"tab\">\n\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon uael-accordion-icon-left\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-closed\"><i class=\"fas fa-angle-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-opened\"><i class=\"fas fa-angle-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"uael-question-6b79aef uael-question-span\" tabindex=\"0\" id=\"uael-faq-1-6a148c4679678\">Is billing fraud a separate criminal offense?<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"uael-accordion-content\" role=\"tabpanel\">\n\t\t\t\t\t\t\t\t\t<span>\n\t\t\t\t\t\t\t\t\t<span><p><span style=\"font-weight: 400;\">No. &quot;Billing fraud&quot; 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).<\/span><\/p><\/span>\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div id=\"uael-accordion-8183eaa\" class=\"uael-faq-accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t\t<div class= \"uael-accordion-title\" aria-expanded=\"false\" role=\"tab\">\n\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon uael-accordion-icon-left\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-closed\"><i class=\"fas fa-angle-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-opened\"><i class=\"fas fa-angle-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"uael-question-8183eaa uael-question-span\" tabindex=\"0\" id=\"uael-faq-2-6a148c46796de\">What are some typical situations that lead to investigations for billing fraud?<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"uael-accordion-content\" role=\"tabpanel\">\n\t\t\t\t\t\t\t\t\t<span>\n\t\t\t\t\t\t\t\t\t<span><p><span style=\"font-weight: 400;\">Frequently, the issues involve allegations of services not being rendered or being rendered incorrectly (e.g., &quot;phantom services,&quot; 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.<\/span><\/p><\/span>\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div id=\"uael-accordion-36f9a7b\" class=\"uael-faq-accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t\t<div class= \"uael-accordion-title\" aria-expanded=\"false\" role=\"tab\">\n\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon uael-accordion-icon-left\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-closed\"><i class=\"fas fa-angle-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-opened\"><i class=\"fas fa-angle-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"uael-question-36f9a7b uael-question-span\" tabindex=\"0\" id=\"uael-faq-3-6a148c4679715\">Do I have to appear in response to a police summons?<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"uael-accordion-content\" role=\"tabpanel\">\n\t\t\t\t\t\t\t\t\t<span>\n\t\t\t\t\t\t\t\t\t<span><p><span style=\"font-weight: 400;\">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.<\/span><\/p><\/span>\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div id=\"uael-accordion-9146b73\" class=\"uael-faq-accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t\t<div class= \"uael-accordion-title\" aria-expanded=\"false\" role=\"tab\">\n\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon uael-accordion-icon-left\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-closed\"><i class=\"fas fa-angle-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-opened\"><i class=\"fas fa-angle-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"uael-question-9146b73 uael-question-span\" tabindex=\"0\" id=\"uael-faq-4-6a148c4679745\">How does a search of a medical practice or institution proceed?<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"uael-accordion-content\" role=\"tabpanel\">\n\t\t\t\t\t\t\t\t\t<span>\n\t\t\t\t\t\t\t\t\t<span><p><span style=\"font-weight: 400;\">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. <\/span><\/p><\/span>\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div id=\"uael-accordion-e3e4d09\" class=\"uael-faq-accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t\t<div class= \"uael-accordion-title\" aria-expanded=\"false\" role=\"tab\">\n\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon uael-accordion-icon-left\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-closed\"><i class=\"fas fa-angle-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-opened\"><i class=\"fas fa-angle-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"uael-question-e3e4d09 uael-question-span\" tabindex=\"0\" id=\"uael-faq-5-6a148c4679774\">What are the penalties for billing fraud?<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"uael-accordion-content\" role=\"tabpanel\">\n\t\t\t\t\t\t\t\t\t<span>\n\t\t\t\t\t\t\t\t\t<span><p><span style=\"font-weight: 400;\">The penalty under Section 263 of the German Criminal Code (StGB) ranges from a fine to five years&#039; 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. <\/span><\/p><\/span>\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div id=\"uael-accordion-200c5cd\" class=\"uael-faq-accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t\t<div class= \"uael-accordion-title\" aria-expanded=\"false\" role=\"tab\">\n\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon uael-accordion-icon-left\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-closed\"><i class=\"fas fa-angle-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-opened\"><i class=\"fas fa-angle-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"uael-question-200c5cd uael-question-span\" tabindex=\"0\" id=\"uael-faq-6-6a148c46797a1\">At what point is damage considered &quot;significant&quot; and why is this important?<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"uael-accordion-content\" role=\"tabpanel\">\n\t\t\t\t\t\t\t\t\t<span>\n\t\t\t\t\t\t\t\t\t<span><p><span style=\"font-weight: 400;\">Case law generally considers a loss of substantial financial value, and thus a particularly serious case, to exist when damages exceed \u20ac50,000 \u2013 based on the individual loss per victim. The amount of damages significantly influences the sentencing range and sentencing. However, damage calculations can be challenged \u2013 the specific calculation method and the underlying assumptions should always be scrutinized.<\/span><span style=\"font-weight: 400;\">.<\/span><\/p><\/span>\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div id=\"uael-accordion-0de18e3\" class=\"uael-faq-accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t\t<div class= \"uael-accordion-title\" aria-expanded=\"false\" role=\"tab\">\n\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon uael-accordion-icon-left\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-closed\"><i class=\"fas fa-angle-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-opened\"><i class=\"fas fa-angle-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"uael-question-0de18e3 uael-question-span\" tabindex=\"0\" id=\"uael-faq-7-6a148c46797cf\">What is the most important defense: intent or harm?<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"uael-accordion-content\" role=\"tabpanel\">\n\t\t\t\t\t\t\t\t\t<span>\n\t\t\t\t\t\t\t\t\t<span><p><span style=\"font-weight: 400;\">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.\u00a0<\/span><\/p><\/span>\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div id=\"uael-accordion-6e27a6b\" class=\"uael-faq-accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t\t<div class= \"uael-accordion-title\" aria-expanded=\"false\" role=\"tab\">\n\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon uael-accordion-icon-left\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-closed\"><i class=\"fas fa-angle-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-opened\"><i class=\"fas fa-angle-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"uael-question-6e27a6b uael-question-span\" tabindex=\"0\" id=\"uael-faq-8-6a148c46797fb\">Does billing fraud always lead to the loss of one&#039;s license or registration?<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"uael-accordion-content\" role=\"tabpanel\">\n\t\t\t\t\t\t\t\t\t<span>\n\t\t\t\t\t\t\t\t\t<span><p><span style=\"font-weight: 400;\">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 (\u00a7 70 of the German Criminal Code) and official revocation of a professional license can also occur cumulatively.<\/span><\/p><\/span>\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div id=\"uael-accordion-c82ed5e\" class=\"uael-faq-accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t\t<div class= \"uael-accordion-title\" aria-expanded=\"false\" role=\"tab\">\n\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon uael-accordion-icon-left\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-closed\"><i class=\"fas fa-angle-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-opened\"><i class=\"fas fa-angle-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"uael-question-c82ed5e uael-question-span\" tabindex=\"0\" id=\"uael-faq-9-6a148c4679829\">When does the statute of limitations expire for billing fraud?<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"uael-accordion-content\" role=\"tabpanel\">\n\t\t\t\t\t\t\t\t\t<span>\n\t\t\t\t\t\t\t\t\t<span><p><span style=\"font-weight: 400;\">The basic offense is subject to a five-year statute of limitations. In particularly serious cases (\u00a7 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. <\/span><\/p><\/span>\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div id=\"uael-accordion-bd1b496\" class=\"uael-faq-accordion\" role=\"tablist\">\n\t\t\t\t\t\t\t\t<div class= \"uael-accordion-title\" aria-expanded=\"false\" role=\"tab\">\n\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon uael-accordion-icon-left\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-closed\"><i class=\"fas fa-angle-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"uael-accordion-icon-opened\"><i class=\"fas fa-angle-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"uael-question-bd1b496 uael-question-span\" tabindex=\"0\" id=\"uael-faq-10-6a148c4679855\">What should I do when I first learn of an accusation?<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"uael-accordion-content\" role=\"tabpanel\">\n\t\t\t\t\t\t\t\t\t<span>\n\t\t\t\t\t\t\t\t\t<span><p><span style=\"font-weight: 400;\">As soon as you become aware of an investigation \u2013 for example, through a summons, hearing, notice of an investigation, or search \u2013 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.<\/span><\/p><\/span>\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Strafverteidigung bei Abrechnungsbetrug im Gesundheitswesen Eine Vorladung als Beschuldigter, ein Durchsuchungsbeschluss f\u00fcr Ihre Praxis, eine Anfrage der Kassen\u00e4rztlichen Vereinigung \u2013 der Vorwurf des Abrechnungsbetrugs trifft \u00c4rztinnen und \u00c4rzte, Zahn\u00e4rzte, Apotheker, Pflegeeinrichtungen und Therapeutinnen und Therapeuten meist unvermittelt und mit erheblicher Wucht. Strafrechtlich wird dieser Vorwurf in der Regel als Betrug nach \u00a7 263 StGB verfolgt [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1433,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-1170","page","type-page","status-publish","hentry"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/galen.de\/en\/wp-json\/wp\/v2\/pages\/1170","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/galen.de\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/galen.de\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/galen.de\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/galen.de\/en\/wp-json\/wp\/v2\/comments?post=1170"}],"version-history":[{"count":27,"href":"https:\/\/galen.de\/en\/wp-json\/wp\/v2\/pages\/1170\/revisions"}],"predecessor-version":[{"id":1438,"href":"https:\/\/galen.de\/en\/wp-json\/wp\/v2\/pages\/1170\/revisions\/1438"}],"up":[{"embeddable":true,"href":"https:\/\/galen.de\/en\/wp-json\/wp\/v2\/pages\/1433"}],"wp:attachment":[{"href":"https:\/\/galen.de\/en\/wp-json\/wp\/v2\/media?parent=1170"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}