Insurers flag unnecessary visits under new outpatient tariff

Health insurers have found excessively high incomes among some specialist doctors and identified possible billing fraud under Switzerland’s new outpatient tariff system, SRF reported. Specialists in dermatology, ophthalmology, urology and surgery are earning more than before the system was introduced at the start of the year.

The tariff reform was intended to reduce incomes in some specialised fields while increasing earnings in family medicine. According to the family doctors association, however, incomes in primary care have not risen.

Saskia Schenker, director of the health insurers association, said insurers had identified areas where payments appeared to be excessive. One possible explanation was that parts of the tariff structure were incorrect and would need to be adjusted.

Insurers were also seeing treatment patterns that suggested some consultations might not be necessary. Schenker cited cases in which the flat-rate payments were designed to cover an entire treatment in one day, but patients were scheduled on two separate days and the flat rate was billed twice.

“That is not allowed,” Schenker said. She added that insurers would seek repayments at the beginning of the year, once the data were complete. “I have to use the harsh word fraud prevention,” she said.

Schenker stressed that many doctors worked honestly and properly, saying the consequences of the new system were a source of shared frustration.

The new Tardoc tariff model was also intended to strengthen family medicine because primary care costs less than specialised treatment and family doctors are in short supply. Schenker said insurers would monitor the situation and take measures with the other tariff partners.