Few fraud reports against healthcare providers lead to prosecution

Health insurers in the Netherlands are overwhelmed with hundreds of fraud reports annually concerning potential misconduct by healthcare providers, yet only a handful of these cases are pursued and even fewer result in legal action. Each insurer receives between 150 and 400 fraud alerts per year, but most are not investigated due to the time-intensive nature of these cases.

A recent investigation by Pointer involving nine insurers highlighted the challenges insurers face due to limited resources. As one insurer clarified, "A report of an expensive car owned by a company director isn’t enough to start an investigation."

Insurers must prioritize cases with stronger evidence to justify an investigation, particularly since fraud investigations can quickly become lengthy and complex. The number of investigations varies among insurers, with smaller companies like Salland Zorgverzekeringen closing only a few cases per year.

Salland recovered partial overpayments in some instances but abandoned other cases when it deemed the chance of reimbursement “very low or nonexistent.” Larger insurers, such as DSW, managed more extensive probes; last year, DSW confirmed fraud in 27 cases, suspending payments or seeking reimbursements where applicable.

The National Labor Inspectorate (NLA) oversees healthcare fraud cases, referring them to the Public Prosecution Service (OM). However, the NLA submitted just 21 cases last year, citing the complexity of healthcare fraud investigations.

Some insurers, including Zilveren Kruis, warned that it remains “too easy to become a healthcare provider,” which sometimes attracts individuals with potentially harmful intentions.