Audit office slams efforts to combat fraud in community healthcare
Efforts to combat fraud in the healthcare system are failing and the chance of being caught is extremely low, the national audit office has said in a new report.
The auditors looked at 14 cases where companies are thought to have committed fraud, involving youth care, community nursing and sheltered housing. They found that while insurance companies and local authorities exchange plenty of information, they do very little to actually establish if fraud has taken place.
And if they do determine that fraud is being committed, little is done to tackle the problem, the auditors say.
‘Regulators, such as the healthcare council NZa and national inspectorates do not have figures showing often healthcare fraud occurs,’ the auditors say. ‘The police and the legal system also lack a good overview. Nor is it clear how much public money is skimmed off by fraudulent healthcare providers.’
Estimates run up to several billion euros per year while health insurers register several tens of millions of euros per year in healthcare-related fraud.
The Netherlands has thousands of small companies offering care services, ranging from community nursing operations to psychiatric services, youth coaching, and residential care.
They are funded by local authorities and health insurance companies, often via PGBs, or personal care budgets which allow people who need care to buy in services themselves.
Fraud can take many forms, often by billing for hours that they did not work, but in some cases companies are claiming cash without providing any services at all.
In February, for example, a scheme to subsidise support jobs in the healthcare sector and free up nursing staff for coronavirus care duties was put on hold because of suspected fraud – and as much as €11m may have been stolen.
In total, 28 of the 32 companies investigated had fewer workers on the payroll than they had asked subsidy for, while nine had never paid any taxes and premiums and seven were sole traders.
The health ministry also admitted in December that some healthcare companies had committed fraud by wrongly claiming bonuses for workers who were not on their books, or by pocketing the money themselves. That problem was particularly acute in companies which provide home nursing or youth care, RTL said at the time.
Research carried out on behalf of the health ministry in Twente and published last year found that several small care organisations had forced their vulnerable clients – often troubled youngsters or people with psychological or addiction issues – to work on marijuana plantations and even trafficked them for sex.
The organisations, often one-person operated companies with a few clients, offered different types of care, including sheltered work programme for groups and individuals, and one offered sheltered housing.
The report also highlighted the lack of information about care firms operating with government money and calls for far better screening processes and controls.
Many of the companies are embedded into a wider criminal circuit involving property, the hospitality industry and transport sectors, the researchers said. In most cases, the researchers were unable to find out any information about the income of the companies or about how many staff they employed, if any.
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