Tackling healthcare fraud is lagging behind despite a critical report from two years ago

NOS News•today, 08:52

Two years after a critical report from the Court of Audit, the approach to healthcare fraud is still not in order. In 2019, 80 million in healthcare money was recovered after fraud, last year this was 16 million. are less likely to detect fraud and the number of cases investigated by the Dutch Labor Inspectorate is relatively low.

De Telegraaf has requested figures from insurers, healthcare agencies and the inspectorate. It shows that two years ago, 380 fraud cases were detected by health insurers, compared to 306 cases last year. Even more striking is that three years ago more than twice as many cases were detected, 649.

The number of cases that actually ended up at the labor inspectorate for prosecution last year was 73. The Public Prosecution Service cannot say how often this led to prosecution, “because this is not kept up to date”, can be read in the newspaper.

Two years ago, a critical report was published by the Court of Audit, describing the effectiveness of combating healthcare fraud. The report showed, among other things, that the approach to healthcare fraud was hardly effective. There was also a “worrying lack of decisiveness,” according to the report. The advice for the Ministry of Health, Welfare and Sport at the time was to urge the authorities to take action more quickly.

The fact that not much has changed since then is also evident from the most recent figures, according to De Telegraaf. In 2019, 80 million in healthcare money was recovered after fraud, last year this was 16 million. Insurers tell the newspaper that they have also transferred fewer cases to the NLA because they are not completed by the inspection.

According to the inspectorate, it is difficult to say why this is the case. The NLA tells the newspaper that it is not faced with a lack of investigative capacity. The authority does wonder whether transferring a file is always the best solution. “An insurer can also take action against a fraudulent healthcare provider and impose a fine or turn off the money tap,” the spokesperson said.

According to Bregje Smans-Verhoof of insurer CZ, one of the reasons why healthcare fraud can hardly be tackled is the risk of detection of the suspects. She says in the newspaper that fraudsters are increasingly able to stay under the radar.

Outgoing healthcare minister Helder indicates in De Telegraaf that the approach to healthcare fraud must indeed be improved. This has been attempted before by mapping the problem, according to Helder, but would not have been successful for various reasons. She does not elaborate on the reasons.