According to André den Exter, Associate Professor of Health Law at Erasmus School of Law, healthcare fraud is not a new phenomenon, but the way in which it is committed and how easy that is, is astonishing. In a column in de Volkskrant, he discusses the phenomenon and the way to combat this issue.
Research of RTL news and the Information Node Healthcare Fraud has shown that criminal entrepreneurs set up care institutions and divert money with dubious constructions. 567 healthcare companies at 212 municipalities are currently classified as ‘dubious’. At the national level, the amount of money that leaks out of healthcare is estimated at millions.
Pointless
Using the increasingly intensive data exchange between different investigative services, it is possible to gain more insight into the problem. However, this approach can be viewed as sticking a band-aid on the wound instead of letting it heal. "As long as entrepreneurs have free rein in starting up a network of unclear legal constructions, and thereby hinder the supervision of provided care, fighting the problem remains pointless," according to Den Exter.
Criminal tricks
From 1 January 2022, a new law will enter into force with a reporting and licensing obligation for starting healthcare providers. Tighter regulation of incorporation requirements for new healthcare institutions is of interest. Nevertheless, some criminals also manage to circumvent this tighter regulation, for example, by appointing and replacing temporary directors from their own network.
Supervision is necessary
Healthcare fraud is very complex and requires a lot of workforce and expertise. Due to this complexity, it is not a priority for the Public Prosecution Service. "In some cases, deprivation claims have been filed, and this has led to the criminal conviction of directors, combined with the seizure of private and business assets. However, so far, it is only a few dozen statements, whether successful or not," according to Den Exter. In the new system, there is only room for contracted healthcare providers. Only under the supervision of funders can they declare services rendered. "Due to the early signalling function and the use of fraud risk indicators, they can suspend payment to criminal healthcare providers and, if necessary, reclaim it through the civil courts. The Public Prosecution Service does not need to be involved in this approach," according to Den Exter.
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Read the entire column here.
