Dubious Middlemen and Greedy Doctors Inside Germany's Medical Tourism Business

German hospitals are earning a billion euros a year with foreign patients. Sarkis Sargsyan is one, and like so many others, the Russian cancer patient fell into the clutches of a questionable middleman and greedy doctors.

Dmitrij Leltschuk/ DER SPIEGEL

By , and

The metastases are scattered around his body like pieces of shrapnel. The German doctors have shown them to him on shaded computer images, which reveal lighter formations in his liver, lungs and brain.

It's a Friday in July 2013. Sarkis Sargsyan, a 46-year-old Russian citizen, is lying on a treatment table in the Klinikum rechts der Isar, a university hospital in Munich. A sign on the door reads "Linear Accelerator III." A mask made of hard blue plastic encloses his hairless skull and face. Two women in white gowns are adjusting Sargsyan's head so that the intersecting red laser beams from the irradiation unit line up precisely with the markings on the mask.

Sargsyan, wearing a black tracksuit, is lying peacefully on the table. His hands are folded across his stomach, his eyes closed. The women turn on the machine, which begins to emit a low humming noise. The radiation is now being targeted at the enemy inside his head.

The story of Sarkis Sargsyan is one of adversity, despair and hope. It's also a tale of allegedly false promises, lavish profits and a brutal lack of scruples. It began in September 2012, when Sargsyan discovered blood in his stool. He went to a hospital in Moscow, where a colonoscopy was performed. "You have a tumor in your intestine, and it doesn't look good," the doctor reportedly said, looking serious. "If you have money," he added, "you should go to Germany. They'll help you there."

The doctor's words reassured Sargsyan because they sounded like an insurance policy. His family owns a small hotel and restaurant in Moscow, and he was convinced he could afford the treatment.

'Treatment in Germany'

He researched German clinics and doctors online with the help of his wife, Nelly, 38, and his brother Derenik, 49.

If you type the words "treatment in Germany" into a search engine on the Russian-language Internet, you get some 3 million hits, including the websites of those who have identified a potential market in people like Sargsyan. An army of "patient facilitators" appears on the screen, offering services to patients that include overcoming language barriers, procuring visas, scheduling flights and, most importantly, setting up appointments at top hospitals and clinics. "You have to be careful with them," the doctor in Moscow had warned Sargsyan.

An acquaintance suggested to Sargsyan that he try IMZ GmbH, a Munich-based agency. IMZ stands for Innovation Medizin Zentrum (Innovation Medicine Center), which sounds impressive enough. When Sargsyan's brother Derenik called IMZ, he described the suspected cancer diagnosis to a doctor named Arsen B., who had attended medical school in Armenia, where the Sargsyans were born. "Come to Munich," the doctor allegedly said. "Then your brother's illness will soon be nothing but a memory."

A few days later, Sarkis, Nelly and Derenik boarded a flight to Munich. But they had no idea how long the trip would last -- and that they were about to begin the worst period of their life.

A Global Market Worth Billions

Even medicine has now succumbed to globalization. Like the Sargsyans, hundreds of thousands of people receive treatment in a foreign country every year. This medical tourism earns German hospitals and doctors roughly €1 billion ($1.35 billion) in annual revenues. In 2011, 82,854 foreign patients were treated in Germany on an inpatient basis and about 123,000 on an outpatient basis. Russians make up the largest group of non-European Union patients in Germany, with about 6,000 receiving inpatient treatment each year. Their share of the total foreign patient population has increased six-fold since 2003. "And the interest keeps growing and growing," says Vladimir Pyatin, Russia's deputy consul general in Bonn, the western city that was once Germany's capital.

Receiving medical treatment in Germany has always been seen as a privilege in Russia. Famed novelist Fyodor Dostoyevsky went to the spa in Baden-Baden, writer Nikolai Gogol searched for a cure for his melancholy in the Baltic seaside resort of Travemünde, former President Boris Yeltsin, who had had five bypass surgeries, had regular checkups at the German Heart Institute in Berlin, and former first lady Raisa Gorbachev was treated for leukemia at the Münster University Hospital.

The reasons for the current boom are simple: The state health care system in Russia has been bled dry. The number of hospitals has declined by almost half since 2000. Many underpaid doctors have left the country. There is a shortage of equipment, and hygiene in hospitals is disastrous. Only 35 percent of Russians are satisfied with medical care in their country.

In comparison, Germany looks like a paradise, with well-trained doctors working with state-of-the-art technology in spotless hospital wards. German hospitals also cater to Russian patients, who, as self-payers, present a lucrative source of income.

This seemingly presents a win-win situation. And that's what it would be if weren't for several factors: the brokers who shamelessly exploit their customers, padding their invoices, urging them to have unnecessary tests done and, in the worst case, sending them home after they have received subpar treatment; the hospitals that turn a blind eye to all of this merely to make a profit; and the politicians who are aware of the legal gray area in which medical tourism lies, yet behave as if they were blind, deaf and dumb.

A Knight in Shining Armor

Sargsyan, his wife and brother landed in Munich on Sept. 16, 2012. They had already paid €3,500 to the IMZ agency as an advance for the treatment and visas, the Sargsyans say.

According to their account, soon after their arrival, they went to the IMZ broker's office at the Sheraton München Arabellapark Hotel.

There, they allege they were greeted by a man in a suit, Arsen B., whose business card listed an exotic combination of titles: "Prof. Dr. med. Dr. h. c. med., neurosurgeon - orthopedics, Director - Senior Physician." B. allegedly promised to make the necessary arrangements for Sargsyan with a network of private clinics and doctors' offices. The family felt like they had met their knight in shining armor.

However, IMZ disputes this account, saying that Arsen B. was abroad on this date and that it does not have an office at this location.

Sargsyan is sitting in a furnished, two-room apartment in northern Munich as he describes his first few days in Germany. He has just returned from radiation treatment, and the blue mask is lying in his lap.

He was a karate fighter and strong as lightning, says his wife, Nelly, a petite, friendly woman. The couple has been married for 21 years. Nelly's description of her husband is a far cry from the person sitting on the sofa. He has dark bags under his eyes, and he looks depressed and exhausted. It's hard to imagine that this man has ever laughed.

Sargsyan talks about how the first appointment took him to the Arabella Clinic, where another colonoscopy was performed. The diagnosis described "a coarse tumor that is not passable." A tissue sample revealed that the tumor was malignant. Doctors also found metastases in Sargsyan's liver and lungs. An interpreter with the agency translated for the patient. "The news was bad," says Sargsyan, "but I trusted the doctors." He also trusted Arsen B., who seemed to have a plan for everything.

To prevent intestinal obstruction, Sargsyan was given a colostomy. Local doctors performed the first cycle of chemotherapy, followed by radiation therapy. The brother handled financial matters, paying €10,000 to the IMZ office for the initial treatment. Because he paid with a credit card, he was also charged a 5 percent surcharge. "Thank you for your confidence," the customer receipts read.

According to the initial estimate, the €10,000 was supposed to cover the chemo and radiation therapy. But soon the brother was asked to pay another €20,000 because the doctors had supposedly forgotten to include the medications in their first bill. No payment, no treatment, Arsen B. reportedly told the brother. That is how Derenik Sargsyan tells the story. However, Arsen B. claims that the additional payment became due because the treatment turned out to be much more complex and costly than originally predicted.

"From the very beginning, patients are told that, generally speaking, the actual doctors' costs are higher than the preliminary cost estimate," Arsen B. says.

During a break in treatment at the beginning of the year, the family returned home to Moscow. After two weeks, Sargsyan suddenly collapsed at home. He was making strange sounds and garbling his words. "Gasoline, I need gasoline," he said, pointing to a water glass.

Doctors in Moscow suspected that there were metastases in his head. His brother Derenik called the IMZ agency in Germany and was told to "come back immediately."

The agency has had a Facebook page since December 2011. The name IMZ is a clever choice because, when it's entered into a search engine, one of the first hits is the home page of the Isar Medizin Zentrum, a well-known private clinic in Munich. The logos of the two organizations -- three curved, parallel arches -- are also strikingly similar. But the agency and the clinic are completely unrelated, and a lawsuit is in the works. The clinic feels that its trademark has been "massively infringed upon."

On the Russian website, the agency advertised until recently its services with flowery slogans, such as: "Life goes on, and we make sure that illnesses don't prevent you from enjoying it to its fullest" and "You will still be able to enjoy the world in all of its colors."

Discuss this issue with other readers!
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DarwinEvolved 11/21/2013
1. Medical Tourism
I am disappointed to see such a turn of events in the FRG. I have considered the possibility of coming to Germany for Medial care, if needed, in the future due to my great respect for Germany and your Medical system. It seems much has changed since my time living in the then West Germany.
kumi-ori 11/21/2013
2. optional
Being a German myself, I would advice all foreigners to contact the hospitals directly. What do you need a broker for, just internet and a friend who can speak a little Englisch in case you don't yourself. Treatment may not be exactly cheap, but I think that the hospitals themselves will inform you fairly about the prices you will expect in case nothing unforeseen should happen. Mr. Sargsyan with metastasized colonic cancer has a poor prognosis. I wish him the best, but I am afraid for him.
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