11/14/2006

The EU's 30 billion healthcare losses

Fraud and corruption network protects 210 million citizens.

Spain – Speaking at the 3rd European Healthcare Fraud and Corruption Conference (EHFCN), Jim Gee, EHFCN director general, reminded delegates that this is the first organisation set up to tackle this problem across Europe. 22 organisations, representing 14 countries and 210 million European citizens, joined the network in the last year. Membership is also being considered by 37 organisations from 19 countries and, if they join, he said the EHFCN would become even more ‘influential and powerful’.

He particularly praised work undertaken by the Ministry of Health in Poland, and the Caisse Nationale de l’Assurance Maladie (CNAMTS) in France, which set up its own Fraud Prevention and Litigation Directorate this year; it provides a ‘road map’ for future success in tackling the problem, he said.

Waiting for fraud to happen will only lead to further losses and reduced standards of care, he added. ‘This could lead to patients being sick for longer, and in some cases, patients dying unnecessarily because they do not receive the care they need.’
In Europe, estimates of healthcare losses due to fraud are at least €30 billion annually. He said those who have already faced this problem have gained more money for healthcare provision. In England and Wales, after the National Health Service (NHS) began taking measures to counteract the problem six years ago, losses were reduced by up to 55% saving €1 billion.

Speakers included leading figures in healthcare and law enforcement agencies from Europe and beyond, for example Jaclyn Zappacosta, Legal Attaché at the FBI’s Healthcare Fraud Unit and Dora Akumyili of Nigeria’s National Food Agency for Food and Drugs Administration.
Jim Gee has now given up his leadership of the network to focus on healthcare fraud and corruption in England and Wales.

Marieke Koken, director of claim control at Zorgverzekeraars Nederland (ZN), a sector organisation for the Dutch healthcare insurers, and new EHFCN Director General, said more criminals must be found and punished. The network is to develop a training database and common training syllabus for all EFCN counter fraud professionals, she said. A manual, due out in 2007, will include detection and investigation methods, supported by case studies showing their success around Europe.

The new EHFCN Executive Committee includes experts in corruption prevention, counter fraud and security, labour and welfare, health and labour insurance and healthcare insurance.
During a month-long Fraud and Corruption Awareness Campaign, this November, one of the aims is for network members to visit hospitals, for example, to talk with staff and patients.
Details: www.ehfcn.org