Health insurers in Germany are reporting a surge in fraudulent claims, costing the system millions of euros each year. The Kaufmännische Krankenkasse (KKH) says it detected damages of around €5.4 million in 2024 alone — ranging from forged prescriptions for expensive medication to billing top-rate wages for unqualified staff.
According to the insurer, the total loss to Germany’s statutory health and long-term care funds reached more than €200 million in 2022 and 2023, marking a new record high. Experts warn that the real figure could be far higher, as many cases remain undetected.
Billing fraud most common in home-care sector
Fraud is particularly widespread in outpatient and home-care services. The KKH reported losses of about €4.1 million in this area alone.
In one case, a nursing provider allegedly billed a training course with an implausibly high number of participants. Other schemes include using stolen health insurance cards and charging for treatments that never took place.
Investigators even uncovered a doctor who billed operations that had never been performed. “These illegally obtained funds are missing from real patient care and can ultimately influence insurance contributions,” said Emil Penkov, chief investigator at KKH.
But Penkov emphasizes that the problem is not only financial. Fraud in the health sector can endanger lives — when patients receive adulterated medication or are denied essential care. “Behind these abstract figures are often tragic personal stories,” he added.
Artificial intelligence enters the fight
Germany’s health-care system is vast and lucrative — a magnet for criminal manipulation. In 2024, statutory health insurance providers spent €312.3 billion on medical services alone.
To counter fraud, investigators are increasingly looking toward artificial intelligence. “Manual checks are no longer sufficient,” Penkov explained. “We must actively uncover hidden fraud structures. AI algorithms can analyze massive billing datasets across insurers and flag suspicious patterns for investigators.”
The new Health-Care Supply Strengthening Act (Gesundheitsversorgungsstärkungsgesetz), which came into force on 1 March 2025, is designed to support this digital approach. The law aims to improve data processing, transparency, and inter-institutional cooperation in detecting suspicious billing.
However, the KKH criticizes that implementation has been slow, with only a few of the planned digital tools and reporting mechanisms actually put into practice so far.
A growing challenge for the health system
Fraudulent billing not only drains public resources but also erodes trust in Germany’s social health model. Investigators hope that machine learning tools will soon help track down fraudsters faster — and ensure that funds return to where they belong: patient care.
