Germany's state-backed insurers are demanding prison sentences of up to three years for doctors who accept bribes or other gratuities. It may seem surprising, but in fact at the moment independent doctors who run their own practices can't be penalized, according to a ruling by the Federal Court of Justice in June 2012. The judges sent a message to lawmakers, saying that this loophole had to be closed soon.

Prior to the ruling, prosecutors had spent years investigating doctors and employees of the German pharmaceutical company ratiopharm. Doctors were allegedly paid to prescribe the company's drugs.

German Health Minister Daniel Bahr is yet to make a decision on the issue, and his spokeswoman said on Wednesday (02.01.2013) in Berlin that she saw no pressure to arrive at a quick decision, as the issue was very complex.

Cooperation with pharmacies and pharmaceuticals

Passarge thinks doctors aren't particularly aware of the problem

Germany's medical system is indeed very complex, and there are plenty of opportunities to take advantages. Lawyer Malte Passarge, head of the anti-corruption organization "Pro Honore", points to the cooperation between German pharmacies and doctors. If a doctor sends his cancer patient to a certain pharmacy for his medication - say one located in the same house - the drugs can easily be worth more than 1,000 euros ($1,320).

In exchange, Passarge says, the pharmacy may show its gratitude for this recommendation by offering the doctor a cut of its profit, or by taking over some of the doctor's staffing or practice costs.

The cooperation with pharmaceutical firms also continues to be an issue. "The health care sector is a big market and its susceptible to such issues," said Passarge. He stressed, however, that it was important not to make blanket accusations.

Isolated cases or epidemic?

But it is not clear exactly how widespread the bribery of doctors is, since evidence is so difficult to gather. Corrupt doctors are usually only uncovered by accident - for instance through tax checks.

In an interview with the German newspaper Frankfurter Allgemeine Zeitung on Wednesday the ruling center-right party's health expert, Jens Spahn (CDU), estimated that there might be thousands of cases of corruption.

Wolfgang Wodarg, former opposition Social Democratic Party MP and now health expert for Transparency International, agrees that the cases are not isolated. "Criminologists say that the cases of corruption in the medical system have now overtaken those in the construction sector."

Only Courts of Professional Conduct can penalise corrupt doctors and revoke their licence. "But these kinds of trials and accusations are quite rare," Frank Ulrich Montgomery, President of the German Medical Council, told Deutsche Welle. While the Council has no data on the total number of cases, figures collected by a regional branch, which comprises the cities of Cologne and Düsseldorf, show that in 2011 seven doctors had to pay a fine of up to 3,000 Euros ($3,900). None lost their licence.

Montgomery: 'Few trials against doctors'

Montgomery is convinced that the laws governing the medical profession need to be honed. "They're a good instrument, but they need to be strengthened." He added that Medical Councils and Professional Courts should be allowed to conduct more investigations. In many cases, he said, obtaining relevant documents and information is difficult.

The corruption debate is heating up

Passarge said that hospitals and other companies operating in the health care sector do support more transparency. The topic has gained importance in the last couple of years, he said.

Other countries, like Great Britain or the US, Passarge said, have more advanced laws concerning medical corruption. He stressed that doctors had to become more aware of the problem. “I've got the impression that the medical profession doesn't really give it much thought.”

Transparency International is currently evaluating new data on observational studies, which the organisation was able to obtain under transparency laws. Pharmaceutical companies pay doctors to observe the side effects of new drugs, Wodarg said. Payments of up to 200 euros ($260) for each patient aren't unusual, he added.

In 2010, 183 such trials were registered with the Federal Association of Physicians, some of them comprising more than 1,000 patients. Wodarg believes that often doctors don't even have to collect data, but are paid for prescribing certain drugs. Some 90 percent of observational studies may merely serve as a cover-upo, Wodarg said.