Time to strengthen the efforts in tackling fraud and waste!
The World Health Organisation considers fraud as one of the ten leading causes of inefficiency in health systems. The average amount of healthcare fraud is estimated to be 6.19% of the global healthcare expenditure for 2013 (or roughly 5.65€ trillion).
These astounding figures resonate even louder in a time when national healthcare systems are put under considerable financial constraints and when governments, payers, healthcare providers and patients are required to spend every single euro with extra care. The recent European Commission’s Country-specific Recommendations (CSR) invite Member States to take measures to contain healthcare costs whose raise represents a risk for the sustainability of social protection systems. An efficient fraud detection system could free up considerable resources to be invested to improve quality and access to healthcare.
Committed to the principle of access to high quality healthcare for everyone, AIM acknowledges that healthcare fraud and corruption represent a tremendous obstacle to universal, solidarity-based and sustainable healthcare systems. Therefore, AIM, through its Working Group dedicated to the Fight against Fraud, underlines the importance for health insurers, healthcare providers and authorities to develop proactive and efficient anti-fraud policies. AIM fraud experts identify several areas to take actions:
- Collaboration with providers and patients should be promoted as many cases of irregularities reported happen to be simple mistakes rather than fraud. Providing constructive feedback and optimising billing procedures would also contribute to more transparency, less mistakes and fraud opportunities;
- The use of e-tools and data mining technics to prevent and detect fraudulent behaviours can play a crucial role to support fraud audits and better allocate resources;
- Multiple approach system implying creation of dedicated fraud units within organisations, the development of corporate compliance schemes and the enforcement of principles of integrity both for employees and affiliates of healthcare insurers are proven to be appropriate and efficient solutions;
- Sharing information about new fraud trends, exchanging best practices and information between health insurers and governments both at national and international level can be a big help, also to tackle the issue of cross-border healthcare fraud.
Together with its partner, the European Healthcare Fraud & Corruption Network (EHFCN), AIM supports the recommendations formulated in the Study on Corruption in the Healthcare Sector ordered by the European Commission in 2013 and asks both the EU and national governments to support the different players involved to fight fraud by helping them to develop innovative and efficient anti-fraud systems through:
- setting clear and effectively enforced anti-fraud and corruption rules
- communicating about the impact of fraud on healthcare systems
- facilitating the exchange of information between stakeholders
About AIM Fight against Fraud Working Group
AIM holds on a regular basis meetings dedicated to the fight against fraud in healthcare. The group gathers fraud experts from all over Europe who exchange about policies and tools to tackle fraud. This working group intends to inspire the members of AIM to take more concrete measures in this field.
The financial cost of healthcare fraud 2015, PKF Littlejohn Counter Fraud & Forensic Services and Centre for Counter Fraud Studies of the University of Portsmouth, 2015
 Study on Corruption in the Healthcare Sector, European Commission, 2013