Health care fraud costs the European Union an estimated 56 billion euros each year, but conflicts of interest within in the pharmaceutical sector mean the full extent of the problem is difficult to measure, say experts.
A recent study by the European Healthcare Fraud and Corruption Network (EHFCN) conducted across seven EU member states discovered 4,188 cases of suspected fraud, with the highest rates found in Belgium and the Netherlands. Overall, losses due to fraud and corruption are estimated to account for nearly 6% of EU governments’ health care budgets, says the Network.
The study shows that health care fraud and corruption can take many different shapes, from dentists claiming fillings they have not performed in Ireland, doctors getting a fee from hospitals when they refer a patient to them in Germany or people creating fake companies with fake employees who claim sick leave in France, said the EHFCN, presenting the findings of its investigation at its annual conference in Brussels.
Cross-border fraud is on the increase, the study also shows; examples include people from the Republic of Ireland accessing the free health care services for Northern Ireland residents by claiming false addresses, and a French patient living in Belgium who claimed for treatment worth 9,000 euros month for 20 years when he was living in a retirement home without receiving any particular treatment.
Fraudulent activities by drugmakers include making false claims about prescription medicines, organising cartels to restrict the supply of key drugs and artificially raising their prices and bribing medical professionals to prescribe their drugs, say critics.
Other contributory factors include Europe’s trade in counterfeit drugs, which is now estimated to be worth more than 10.5 billion euros annually; worldwide the market for fake drugs is expected to reach 60 billion euros this year.
The conference discussions on the controversy over the World Health Organisation (WHO)’s handling of the H1N1 pandemic, and the Organisation’s refusal until recently to reveal the identities of its emergency committee members, heard from Professor Marc Bogaert of the University of Gent, Belgium that "withholding information on conflicts of interest is also a crime." It is alleged that the criteria for declaring a pandemic were changed on the advice of three experts who received consulting fees from drugmakers, so "it could easily have been applied to a sneeze," said Angela Spelsberg of Transparency International, according to a report from Euractiv.
A law passed in Belgium in 2007 has increased health care professionals’ accountability and provided a tool for inspectors at the National Institute for Health and Disability Insurance (INAMI/RIZIV) to prevent and reduce losses due to fraud, error and waste. These new powers have already enabled around 1,000 cases to be investigated, with fines and recoveries totaling 8.5 billion euros achieved so far, the meeting heard.
The Belgian Presidency of the EU is also promoting practical cross-border cooperation between magistrates in neighbouring zones to enable them to request, use and exchange information at an international level in matters of tax, social security, health and justice.
"Make no mistake – healthcare fraud is a killer," according to EHFCN President Paul Vincke. "No government can afford nor allow the human suffering that is always there at the end of the line as a patient stays ill longer or eventually dies for not getting the treatment he or she was entitled to. This can no longer happen," he told the conference.