Organized crime increasingly involved in healthcare fraud; OM not equipped to fight it

Organized crime is increasingly involved in healthcare fraud, and the Public Prosecution Service (OM) is unable to adequately combat it, two prosecutors told Pointer and Follow the Money. They’d like to see municipalities and health insurers do more to combat fraud before it comes to the point of criminal prosecution.

Recently, the Healthcare and Youth Inspectorate warned of criminal networks helping freelancers find work in the healthcare sector with fake diplomas and certificates. According to OM, the suspects involve people previously linked to things like ATM bombings and drug trafficking. “Organized crime—and we are talking about serious criminals—are increasingly interested in the pot of healthcare money,” prosecutor Marjolein Verwiel told the investigative journalists. According to her, healthcare fraud is safer than violent crime and quite lucrative.

“We assume that 10 percent of the 100 billion euros annually spent on healthcare is defrauded. Ten billion euros a year,” said prosecutor Timon van der Kraats. According to him, these criminal networks sometimes overlap or collaborate. “They are learning organizations that are particularly well informed about the laws and regulations.”

The OM can’t tackle this growing problem alone. “The OM is just a closing item. We are not the solution,” Verwiel said. The two prosecutors advocate for more cooperation with the sector, health insurers, municipalities, and the central government. The current situation is a “fragmentation infarction,” they said.

The Netherlands has over 300 municipalities, each responsible for healthcare within its borders, Verwiel explained. “If you are caught committing fraud in one municipality, you simply go to another. Municipalities cannot warn each other on a large scale. It is also questionable whether they have sufficient capacity and knowledge to combat fraud. Some municipalities do not even have a supervisor; others sometimes have to check hundreds of providers on their own.”

“A criminal can operate within that without quickly getting caught,” Van de Kraats said. And if a case does end up in court, it is often complex and can take years before a final verdict is reached. All the while, suspects can continue setting up new companies in different municipalities and continue their fraud.

Health insurers complain that they take fraud cases to the OM, and they go uninvestigated. According to Verwiel, the OM has to be selective about who it prosecutes. “The system is clogged. We cannot take on all cases under criminal law,” Verwiel said. “We mainly look at whether we can tackle an abuse that is broader than just one healthcare provider. We want to send a signal with it.”

“With the police’s healthcare fraud detectives, we can only handle about 20 cases per year. But because of the scale of the problem, it is desirable that more attention is paid to this problem,” Van de Kraats added.

“We would like to see municipalities and insurers think about how they can reduce the influx of fraudulent healthcare companies,” Verwiel said. “If it involves so much money, it might be smart to Google who you are doing business with. Find out who you are dealing with, go and have a look at the building they’re located it. It sometimes amazes me how many parties municipalities enter into contracts with without checking essential matters.”