€56 billion is lost to healthcare fraud each year in the EU, but experts say conflicts of interest in the pharmaceutical sector mean that the true extent of expenditure being directed away from patients remains unknown.
Low quality treatment – including from unqualified practitioners, forged receipts and sickness certificates, price cartels and the provision of counterfeit medicines – were identified as contributing to a phenomenon difficult to measure but ringing alarm bells at a time when austerity measures are being undertaken across the EU.
New research presented by the European Healthcare Fraud and Corruption Network (EHFCN) at its annual conference in Brussels (28 September) highlighted the strain fraud puts on the health service.
4,188 instances of suspected fraud were identified in the study, which was carried out in seven member states. The Netherlands and Belgium – working under a 'pay for service' system where doctors have an incentive to provide as much treatment as possible – hold the highest rates.
The case of Derry v. Peek 1889 in the UK established the definition of fraud as including a false statement "made knowingly, or without belief in its truth, or recklessly, careless whether it be true or false".
EHFCN President Paul Vincke asked, "if detected fraud losses go up, does that mean that there is more fraud or that there has been better detection?"
Cross-border healthcare exacerbates problem
The phenomenon of 'healthcare shopping' was identified as being a major source of fraud due to the current lack of cooperation between customs, the police and healthcare organisations in exchanging sensitive information on tax and social security.
Examples included people from the Republic of Ireland accessing free healthcare services designated for Northern Ireland residents by claiming false addresses, or a French patient living in Belgium who claimed €9,000 a month for expensive treatment for 20 years whilst living in a home for elderly without receiving treatment.
Solutions through cooperation
The Belgian strategy of 'information, control and evaluation' founded by Dr Bernard Hepp involves healthcare professionals carrying out judicial checks on providers' behaviour, with citizens being assigned a single 'unique bar code' for all social security benefits so as to render the task of detecting fraud – difficult due to the number of public and private players involved – a little easier.
€8,500,000 has already been clawed back in the form of recoveries and fines after 1,000 cases were investigated in this way.
The empowerment of doctors by institutions increasing their transparency so as to encourage whistle blowing in the sector was seen as necessary by all, so that peer pressure could have an effect in richer countries and "survival corruption," as Dragana Jovanovic of Belgrade university put it, could be reduced in poorer ones.
A 'code of practice' based on agreed values with regard to the receipt of gifts by medical professionals with which the industry may regulate itself was called for by some, with others favouring banning them altogether.
Plans to allow pharmaceutical companies to advertise medicines in newspapers were scrapped by MEPs last week, but one participant lamented the fact that doctors still receive a 'medical newspaper' filled with adverts twice a week.
Swine flu 'didn't exist'
With regard to fraud cases in health care, "witholding information on conflicts of interest is also a crime," Bogaert affirmed.
The WHO has until now refused to reveal the identity of its emergency committee members who issued the pandemic warning for the H1N1 or 'swine flu' virus.
It has been alleged that the criteria for labelling a pandemic was changed on the advice of three experts who received consulting fees from the pharmaceutical industry, so that "it could easily have been applied to a sneeze," according to Angela Spelsberg of Transparency International.
Participants called on the media to investigate "the story behind the story" in order to highlight cases of fraud across the board.
The European Healthcare Fraud and Corruption Network carried out a study in Belgium, France, the Netherlands, Northern Ireland, Norway, Poland, Slovenia and Scotland in order to determine the burden healthcare fraud places on society and facilitate the exchange of best practice on its detection.
The vast number of parties involved in the healthcare sector and the subsequent potential complexity of fraud schemes means that special fraud detectors - professionals already working in health care - have to be employed in order to carry out investigations into bills, patient notes and medication receipts.
Trade in counterfeit medicines has exploded and it is now estimated that global counterfeit drug sales will reach €60 billion this year. In Europe alone, the fake drugs market is estimated to be worth more than €10.5bn every year.
EU official documents
- European Commission:Proposal for a Directive on the application of patients' rights in cross-border healthcare
- European Parliament:Hearing on lessons of Influenza A (H1N1) pandemic
- World Health Organisation:H1N1 in post-pandemic period
NGOs and Think-Tanks
- Centre for Counter Fraud Studies:The financial cost of healthcare fraud
- International Medical Travel Journal:The EU Directive on cross border healthcare... where are we now?