KKH reports over eight million euros in billing fraud losses

The KKH Kaufmännische Krankenkasse has reported more than eight million euros in damages resulting from billing fraud during the 2024 and 2025 period, marking its highest losses within a two-year span.

The fraud involves various methods, including forged prescriptions, unrendered nursing services, and the use of unqualified personnel. While pharmaceutical fraud accounted for approximately 875,600 euros in losses in 2025, the nursing sector remains a major concern. In the previous year, 65 percent of new suspicious cases reported to the KKH investigation group were related to nursing services.

Investigators have identified “mafiösen Strukturen” (mafia-like structures) operating across federal states and even internationally through shell companies. The KKH is utilizing artificial intelligence to detect suspicious patterns, though legal limitations currently restrict the ability to cross-reference data with other health insurance providers.