Dutch health insurers: more fraud visibility through cooperation


Dutch health insurers completed over a thousand fraud investigations in 2021. 649 cases actually revealed fraud, totalling over EUR 17 million. Health insurers are increasingly cooperating with the Dutch Labour Inspectorate and regulators NZA and IGJ because they see that fraud investigations are becoming increasingly complex. They are also making additional efforts to prevent fraud. This is stated in the annual report on fraud control 2021 of all health insurers in the Netherlands.
Health insurers see that fraud investigations are becoming increasingly complex. When investigating fraud signals, health insurers are therefore working more and more intensively with the Healthcare Fraud Information Hub, where signals can be shared with chain partners such as the Dutch Healthcare Authority (NZa), Healthcare and Youth Inspectorate (IGJ) and Dutch Labour Inspectorate (NLA). In this way, obstacles such as insufficient investigative powers, lack of cooperation or documentary evidence can be overcome.

Annual report
Last year, 1053 fraud investigations were completed, more than 200 more than in 2020. Fraud was detected in some 60% of the cases investigated, including in the district nursing (54%) and paramedical care (16%) sectors. In addition, fraud was relatively often detected with personal budgets for long-term care (13%). After establishing fraud, health insurers take action against the healthcare provider concerned.

Fraud management
In the Netherlands, we attach great value to good healthcare. It is important that money earmarked for care is spent on care. Healthcare fraud undermines the healthcare system. That is why health insurers also take action against it, for instance by investigating signals of fraud. Fraud management has an appropriate place in all health insurers’ processes, such as health care purchasing policy and claims processing. Health insurers always seek a good balance between trust and control when managing fraud. They focus as much as possible on prevention: prevent where possible, only investigate and punish where necessary. That way, less healthcare money is lost and fewer investigations are needed.