“The public prosecution service is not doing enough to tackle healthcare fraud”

Decline in prosecutions: capacity determines outcome

The Functional Prosecution Service (FP) ought to prioritise tackling healthcare fraud, yet statistics show that the number of prosecutions is falling short. “The risk of being caught is already extremely low”, says Buijsen. “And even if it does happen, you clearly have very little to fear.” According to him, the root cause lies in structural capacity problems within the Public Prosecution Service (OM). “It is well known that the OM has been underfunded by the government for years and, as a result, is understaffed.”

Buijsen understands that not every suspect can be prosecuted, but finds the current situation alarming. “To speak of a structurally failing system goes too far. It is simply a fact that not every offence can be detected and prosecuted, and the deterrent effect of criminal law is always relative. But right now, the Public Prosecution Service is showing far too little. The OM really ought to make it much clearer that it considers healthcare fraud to be a serious social evil.”

Investment and alternative choices are needed

According to Buijsen, the solution is not only about making tougher choices within the FP, but also about making political decisions. “The OM cannot enforce what it does not have the capacity to handle. And if the government does not prioritise this, the system is deliberately being undermined.” He advocates for more investment in staffing and expertise. “Given the public outcry about healthcare fraud, investing in people and expertise would be a sound decision.”

Buijsen further suggests that it may be worthwhile to tackle healthcare fraud more frequently under administrative or civil law, for example by recovering funds or issuing fines. However, it would be even better to prevent fraud from happening in the first place. “Right now, the focus is mainly on monitoring and enforcement. But it would be better to prevent healthcare fraud by putting more robust controls in place ‘at the front end’. The system of personal healthcare budgets (PGBs) is highly susceptible to fraud, and it might be time to consider an alternative. The choice for PGBs was introduced for the sake of patient autonomy, but that autonomy now comes at a significant cost. The precise scale of healthcare fraud is unknown, but the OM itself has estimated it at roughly €10 billion — almost 10% of total publicly funded healthcare expenditure. Perhaps it is time to ask ourselves just how much that autonomy is worth. In curative care, restitution policies have been discontinued this year. There has been little complaint about that.”

Transparency and risk

In addition to the issues of capacity and regulation, Buijsen also raises a critical point about the FP’s transparency. “It has become nearly impossible to find out why the OM is doing so little to combat healthcare fraud. Until a few years ago, the OM published a Fraud Monitor every two years, but it has stopped doing so.”

Finally, he warns that organised crime may be making systematic use of this vulnerability in the system. “We have too little insight not only into the scale of the problem, but also into the ways in which healthcare fraud occurs. Yet when such large sums of money are involved, organised crime is never far away.”

Investing in detection and prevention

Martin Buijsen is clear: those who are serious about tackling healthcare fraud must be prepared not only to act decisively, but also to make substantial investments in staffing, expertise and better prevention. “Resources are scarce, and the demand for healthcare is growing. This means that we simply cannot afford to lose a single euro to fraud.”