The Hirslanden group is criticized.Image: Keystone
Swiss hospitals charge sky-high prices for implants, up to 25 times their actual cost. They are thus taking advantage of a loophole.
Swiss hospitals are using a new method of billing for implants that is allowing them to make huge profits. The Hirslanden group, for example, would have billed nearly 1,500 francs to a health insurance fund for an implant costing only 60 francs, report Tamedia headlines.
But that’s not all: the group would also have received 2,800 francs for a stent worth barely 300 francs. And the amounts climb further: a cardiac pacemaker, normally sold for 3,700 francs, would have been billed for 14,500 francs.
Hirslanden is not an isolated case. Another hospital would have charged around 54,000 francs for a cardiac pacemaker, the real cost of which is estimated at only 11,000 francs, according to our colleagues.
A common practice
This investigation therefore highlights a new practice used by certain hospitals to generate profits: overbilling for medical products, to insurance, at rates well above the purchasing costs from suppliers. Ultimately, it is the contributors, through their premiums, who bear the costs, and therefore the Swiss.
Medical establishments generally benefit from significant discounts when purchasing medical equipment, especially for implants. These reductions, sometimes very substantial, are supposed to be passed on to health insurance, in accordance with the law. However, in practice, this obligation is not always respected.
By amending the law, parliament sought to encourage hospitals and medical practices to negotiate firmly with their suppliers, while ensuring transparency on the discounts obtained.
Exploit a loophole
Hospital institutions therefore used fictitious discounts, according to Tamedia. Under the legislation, they are allowed to keep part of the discounts negotiated with suppliers. This flaw would have been exploited systematically, particularly by the Hirslanden group.
The latter claims to have mandated a law firm to conduct an external investigation and identify possible errors in its billing. “This is currently determining, within the framework of a detailed control procedure, whether errors were made during the implementation of the contractually stipulated withholding of benefits and invoicing,” said Claude Kaufmann, spokesperson for the group.
For their part, health funds, notably the CSS, also examine these practices. “We have observed that certain healthcare providers systematically apply this principle,” explains a CSS spokesperson. According to them, these service providers systematically charge amounts well above the actual costs. (jah)
