Tackling healthcare fraud in the Netherlands is under pressure due to limited capacity and a rising trend in fraud cases. Health insurers are tasked with detecting fraudulent activities and report them to the Labour Inspectorate's Investigation Service (NLA). Recent data shows that only a fraction of these reports are actually investigated. Martin Buijsen, Professor of Health Law at Erasmus School of Law, shared his concerns and insights on this in a Telegraaf article.
Research and capacity problems
The NLA receives a lot of reports of major health insurer fraud cases every year but can only handle a limited number of them. In 2023, 84 cases were reported, while the NLA completes only 16 to 20 investigations a year. Buijsen argues that this sends a worrying message. "Health insurers in particular are essential in tackling healthcare fraud because they are on top of a mine of information", Buijsen said.
In his additional response, Buijsen indicated that the capacity of the NLA will never be sufficient to deal with all major healthcare fraud cases. "I think it is naive to assume that such capacity will ever be able to be adequate. For that, resources are too limited and there is a total lack of real political will." He also stresses that healthcare fraud is relatively rare in forms of care insured under the Health Insurance Act, while the Social Support Act 2015 is much more susceptible to fraud.
Effectiveness of criminal prosecutions
The effectiveness of criminal prosecution as a deterrent to future healthcare fraudsters is difficult to measure, according to Buijsen. "To my knowledge, that has never been studied. What can be said meaningfully about the deterrent effect of criminal law also applies - to the extent that anything meaningful can be said about it - to healthcare fraud."
Buijsen advocates a preventive approach. He explains that healthcare fraud can best be fought 'ex ante'. Non-contracted care providers and personal budgets (pgb's) are particularly vulnerable to fraud. "Because health insurers have far-reaching control options with regard to contracted care providers, from whom care is purchased on behalf of policyholders with a non-contractual insurance policy, care fraud occurs much less there", Buijsen says. According to him, reducing restitution insurance is an effective way to combat fraud.
Improving collaboration
For a better approach to healthcare fraud, Buijsen says closer collaboration between health insurers, the NLA and the Public Prosecution Service (OM) is crucial. He suggests that health insurers make full use of their legal control options and actively use private law measures. "Stop offering restitution insurance and use the legal control options when necessary", Buijsen said. In addition, health insurers can recover damages and contract carefully to limit fraud.
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