The medical practitioners at the heart of the investigation are said to have enriched themselves by issuing false prescriptions and billing for fictitious services.
The case dates back to 2017 and was denounced by another doctor at the time. The National Health Fund (CNS) took the case to court the following year. Since then, an investigation was launched into the allegations that selected practitioners committed fraud and falsified documents.
According to Reporter.lu, the investigation is focused on three people, although the doctors, all of whom practice geriatric medicine, are yet to be charged. Among the allegations is the fact that the practitioners engaged in “parallel treatment”, systematically ordered for elderly patients in hospital, meaning that two doctors were charged with a patient’s care simultaneously. Although the practice is not prohibited as such, it is generally considered to be inappropriate in these cases. When questioned, the judicial authorities confirmed that an investigation was underway, without supplying details.
Maître François Prum, the legal representation for two of the doctors affected by the case, refuted the accusations.
“As I have already expressed clearly to Reporter.lu, our position is to say that doctors have always been billed solely on the basis of the CNS nomenclature, through an agreement which is both compliant with the CNS and AMMD (Luxembourg’s association of doctors) framework. Now this seems to pose an issue of interpretation relating to the way this compensation should have been completed.”
The matter relates to an alleged verbal agreement in 2009 with a CNS director, who has since retired.
René Metz, director of CHEM since 2021, declined to grant an interview on the investigation. In the article by Reporter.lu, Metz is quoted as saying that practitioners of geriatric medicine are disadvantaged by the nomenclature, meaning their remuneration does not correspond to their work. He attributes this to an unhealthy and archaic attitude belonging to the CNS as well as a poor understanding of the modern hospital system. “This is not a reason to issue falsified documents,” clarified the Esch hospital’s press office, adding that the article contained a lot of information and there was little more to added at the present time. The hospital appealed to the judicial authorities to continue their work.
The Ministries of Health and Social Security issued statements emphasising that they would carefully follow any reports of potential abuse.
The nomenclature for different medical specialisations is continually adapted on the basis of article 65 of the Social Security Code.
