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AOK Plus Reports an Increase in Reports of Misconduct

AOK Plus Reports an Increase in Reports of Misconduct
According to its own figures, the health insurance company processed 1,667 reports and cases from 2024 to 2025. (File photo) / Photo: Karl-Josef Hildenbrand/dpa
From: DieSachsen News
The number of suspected cases reported to AOK Plus has risen significantly. Why long-term care insurance is a particular focus.

Whether it’s billing fraud or corruption: Reports of misconduct in the healthcare sector have risen at the AOK Plus health insurance company in Thuringia and Saxony. According to its own figures, the health insurance provider processed 1,667 reports and cases from 2024 to 2025—a 44 percent increase compared to the 2022/2023 reporting period. 

The health insurance provider estimated the total losses over the past two years at approximately 2.9 million euros, of which about 2 million euros were recovered. According to the report, the tips led to criminal charges in 60 cases. The data indicates that about 85 percent of the tips came from insured individuals, family members, investigative authorities, or service providers.

Every euro that is misused ultimately deprives people who depend on medical care or nursing care, said Ilona Wojnowski, a member of the AOK Plus executive board. “Anyone who intentionally abuses the system is therefore not harming a single health insurance provider, but the entire community of insured individuals,” she said, according to the press release.

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Most Cases Involve Long-Term Care Insurance

As an example of fraudulent billing, the health insurer cited a nursing home where the management had submitted false invoices and diverted the additional revenue to themselves. According to the report, employees reported this after the facility was taken over by a new operator.

With around 400 cases, the majority of reports were related to long-term care insurance. In this area, low barriers to accessing individual services, cash billing, and minimal documentation requirements were being specifically exploited.

In addition, there has been an increase in cases involving insured-person-related and medical services. However, the electronic patient record helps insured individuals better track their data and report irregularities more frequently, according to AOK Plus. 

Report Suspected Cases

The health insurance provider stated that it investigates every specific report of possible misconduct. In doing so, it works closely with investigative authorities, the associations of panel physicians, other health and long-term care insurance providers, and the National Association of Statutory Health Insurance Funds. 

Accordingly, insured individuals, family members, and healthcare workers can report suspected cases confidentially online, by phone, or by mail.

According to its own figures, approximately 3.5 million people—slightly more than half of all those with statutory health insurance in Saxony and Thuringia—are insured with AOK Plus.

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