Care agencies can't stop personal healthcare budget fraud: Dutch health authority

Health insurance
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Care agencies do not have enough possibilities to stop fraud with personal healthcare budgets, Dutch healthcare authority NZa concludes, calling for the rules to be adjusted, NOS reports.

A personal healthcare budget is a type of health insurance in which a person with disabilities or with another need for long-term care is allocated an amount of money with which he can arrange care for himself. The patient himself is responsible for making sure that the money in his personal budget is used correctly. Care agencies must assess on behalf of insurance companies whether clients are eligible for a personal healthcare budget. The care agencies are also responsible for concluding contracts with care providers that are covered by the Long-term Care Act, according to NOS. 

After investigation, focused primarily on retrieving wrongly paid personal budget money, the NZa concluded that care agencies are powerless to act against healthcare providers who do not abide by the personal healthcare budget rules. For example, they have no way of stopping fraudulent providers to offer their services elsewhere. Care agencies can advise their clients to buy their care somewhere else, but they can't do much against fraudulent providers themselves, according to the NZa.

For example, care agencies do not have access to healthcare provider's administration, making it very difficult to get evidence of fraud. The NZa therefore wants to make it mandatory for providers to give access to their administration if care agencies request it. It is also currently very easy for a provider to start up again if it was declared bankrupt due to fraud or mismanagement. The NZa therefore wants stricter requirements for people who want too be a healthcare provider. 

The NZa also finds it undesirable that underage personal budget holders are legally responsible for the proper spending of their budget. This means that if their parents commit fraud with the budget, the children are responsible for repayment. The NZa wants the parents of children with a personal budget to have responsibility for that budget. 

The NZa encountered numerous cases of fraud during its investigation. For example, providers arranging less daytime activities for mentally disabled people than they claimed from the personal budget, or using money from the personal healthcare budget for non-care related expenses. 

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