{"id":3779,"date":"2013-11-05T15:38:53","date_gmt":"2013-11-05T15:38:53","guid":{"rendered":"https:\/\/www.mth-partner.de\/?p=3779"},"modified":"2025-10-28T07:00:09","modified_gmt":"2025-10-28T07:00:09","slug":"sozialrecht-zivilrechtliche-und-strafrechtliche-folgen-des-abrechnungsbetruges-eines-pflegedienstes","status":"publish","type":"post","link":"https:\/\/www.mth-partner.de\/en\/social-law-civil-and-criminal-consequences-of-billing-fraud-by-a-care-service-provider\/","title":{"rendered":"Social law: Civil and criminal law consequences of billing fraud by a care service"},"content":{"rendered":"

Local Court Bensheim, 17 November 2004, 22 Js 13439\/99 - 5 Ls VII<\/strong><\/p>\n

Due to the ageing society and the increasing workload of the younger generation, outpatient care services have taken on an important function in our society.<\/p>\n

People with dementia, mental illness or disabilities in need of assistance are cared for and supported by the care services in their homes, thus ensuring that those in need of assistance can remain in their familiar surroundings for as long as possible.<\/p>\n

Although the majority of outpatient care services do a very good job, it can happen that individual care services are paid for services that are not provided or that individual services of the care service are provided by non-qualified staff.<\/p>\n

If there is such misconduct on the part of the care service, there may be consequences under criminal and civil law. Under civil law, a care service can be ordered to refund the remuneration and possibly to pay damages or compensation for pain and suffering.<\/p>\n

Under criminal law, the billing of services not provided or the provision of these services by non-examined staff constitutes fraud in accordance with Section 263 of the German Criminal Code (billing fraud).<\/p>\n

In the above-mentioned case before the Bensheim Local Court, treatment care services were provided by unqualified nursing staff in breach of contract.<\/p>\n

<\/span>Facts: Breach of the care contract<\/span><\/h3>\n

The defendant was the owner of an outpatient care service and had stipulated in a care contract that the necessary treatment care services were to be provided exclusively by qualified staff. This was a contractual obligation that met the quality standards expected in the care sector. Nevertheless, in 87 cases the defendant had the nursing services provided by non-registered staff and subsequently invoiced them as if they had been carried out by qualified staff.<\/p>\n

<\/span>Criminal law assessment: Commercial fraud<\/span><\/h3>\n

The Bensheim District Court considered the defendant's behaviour to constitute the offence of commercial fraud pursuant to Sections 263 (1) and (3), 53 StGB. By billing for the nursing services, the defendant gave the impression that the services had been provided by qualified, registered staff, although this was not the case. Another key aspect of the fraud was that the higher labour costs for the qualified staff were stated in the invoice, although these services were not billable if they were performed by unqualified staff.<\/p>\n

<\/span>Extent of damage and number of cases<\/span><\/h3>\n

The defendant's behaviour caused considerable damage, which was reflected in the large number of cases and the unauthorised billing. The court recognised that the defendant's systematic approach constituted repeated fraudulent behaviour. In total, there were 87 cases in which the care services provided did not correspond to the contractual agreements and therefore constituted unlawful enrichment.<\/p>\n

<\/span>Sentence: mitigation through confession<\/span><\/h3>\n

The Bensheim Local Court sentenced the defendant to 1 year and 10 months' imprisonment. This sentence reflected the seriousness of the offence, in particular the commercial nature of the fraud and the damage caused. However, the court mitigated the sentence by taking into account that the defendant had fully confessed and had therefore helped to clarify the facts of the case. This led to a reduction in the sentence without a suspended sentence being imposed.<\/p>\n

To summarise, the case shows that the abuse of care contracts and the systematic billing of unqualified services have serious legal consequences.<\/p>\n

Source: Bensheim Local Court<\/p>\n

Lawyers in Cologne advise and represent you in social law.<\/a><\/p>\n

Important Note: The content of this article has been prepared to the best of our knowledge and belief. However, due to the complexity and constant evolution of the subject matter, we must exclude liability and warranty.<\/b> Important Notice: The content of this article has been created to the best of our knowledge and understanding. However, due to the complexity and constant changes in the subject matter, we must exclude any liability and warranty.<\/p>\n

If you need legal advice, feel free to call us at 0221 \u2013 80187670 or email us at info@mth-partner.de.<\/p>","protected":false},"excerpt":{"rendered":"

Through their services, outpatient care services can enable those in need of care to live in their familiar surroundings. To this end, the legislator grants numerous benefits. In particular, care insurance pays for the services provided by the outpatient care service. However, if the care service does not bill for the services provided, this can have consequences under civil and criminal law. <\/p>","protected":false},"author":4,"featured_media":11739,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[38],"tags":[2701,2702,2518,2616],"class_list":["post-3779","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-erbrecht-anwalt","tag-aerger-mit-dem-pflegedienst","tag-fehlverhalten-des-pflegedienstes","tag-rechtsanwalt-koeln-pflegeversicherungsrecht","tag-verguetungsanspruch-pflegedienst"],"yoast_head":"\nSozialrecht: Zivilrechtliche und strafrechtliche Folgen des Abrechnungsbetruges eines Pflegedienstes<\/title>\n<meta name=\"description\" content=\"Rechnet ein Pflegedienst Leistungen ab, die er tats\u00e4chlich nicht erbracht hat, kann dies erhebliche strafrechtliche und zivilrechtliche Folgen haben.\" \/>\n<meta name=\"robots\" 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