Paul Vincke talks on how the EHFCN tries to counter fraud and corruption

 

Around 100 delegates from 16 countries representing Ministries of Health, sickness funds, healthcare providers and other parties committed to strengthen co-operation in their fight against healthcare fraud and corruption throughout Europe. 

What is the EHFCN and what does the organisation do?

The EHFCN is a not for profit international association which helps its members to counter fraud and corruption in healthcare. Our core business is to highlight any possible issues and items associated with this subject.

Losses to healthcare fraud and corruption annually across Europe are estimated at between €30 and €100 billion. With the introduction of the EU Directive on cross border healthcare steps are being put into place to combat and recover the billions of Euros fraudulently lost

We are the only European organisation dedicated to combating healthcare fraud and corruption across Europe and one of our goals is to bring back money to healthcare services for the benefit of every patient. We provide our members with information, tools, training and assistance in fighting fraud and corruption and also offer a platform for members to exchange information and ideas.

What was the purpose of the Edinburgh conference?

The main purpose of this conference was to raise awareness of the problems and issues associated with healthcare fraud and corruption within the EU and how the ratification of the EU Directive on Cross Border Healthcare will impact on patients and providers.  We additionally saw this as an opportunity to raise awareness of the types of problems that may arise as more patients travel within Europe for healthcare and as more providers set up in various locations across Europe.

We also wanted to inform attendees about the three main objectives of EHFCN which all work together and how important the integration of all elements is in combating fraud and corruption. 

  • The first element is raising awareness about the ethical and moral issues surrounding fraud and corruption and how vital it is to foster a culture of integrity for both patients and providers within the healthcare community.
  • The second objective of our organisation is advising on risk measurement and countering fraud and corruption and offering members advice about the instruments and tools available to do that.
  • Our third objective is on sanctioning and the legislative processes used to deal with corruption and how we are helping to create new procedures for sanctioning.

Why do you need all three elements?

All three elements are essential because if you’re only focused on trying to raise a higher level of integrity among consumers and advisors without the threat of being sanctioned it won’t work. Sanctioning works on three levels, penal, civil and disciplinary; we offer advice to members on both morals and sanctioning. Risk measurement is very important in order for entities to identify the problem and what the amplitude of the problem is and what needs to be assessed and analysed.

Our aim is to help remove the opportunities for fraud and corruption but in reality the individual who wants to commit will always look for an opportunity. We don’t want to pretend we can completely eradicate fraud but it is essential that we set our standards at the highest level.

Is cross border healthcare fraud and corruption currently a big issue?

The subject of cross border healthcare is high on EU commission’s agenda and is starting to draw attention from health care partners throughout Europe.   Some countries and public and private sector healthcare providers still consider this to be a minor issue and budgetary wise the investments are currently minor.  We feel that the issue of fraud and corruption in cross border healthcare has been sidelined and thought as of as a minor problem and not being followed as closely as it should.  One of the intentions of the conference was to raise awareness of the issue and we had a number of speakers addressing it from different angles including Willy Palm, a speaker from the European Observatory in Health Care (a spin off from the WHO) who spoke about how EU directive came about. He also spoke about the opportunities and pitfalls it presents to both healthcare consumers and providers and Keith Pollard of Treatment Abroad spoke about the Directive’s impact from a patient’s perspective.

How is the EHFCN coordinating its approach to managing fraud and corruption in cross border healthcare?

Fraud and corruption in relation to Cross Border Healthcare needs to be looked at from all angles not just patient perspective which is the most obvious angle.  We are looking at all of the different entities concerned in cross border healthcare - practitioners, healthcare providers and suppliers and healthcare.  Our scope is as wide as possible and we are looking at the potential for fraud and corruption wherever people spend money on health, welfare and wellbeing in both the private and public sector.

For example, we think that as well as the directive encouraging patient mobility that it will also encourage mobility of healthcare providers in both private and public sector and therefore the opportunity for fraud and corruption exists there as well.

Who do you think will commit fraud as more people travel for healthcare – patients or professionals?

Both - and this is potentially a huge problem for the health care system. In every country there are people, whether they are patients or practitioners or suppliers who will try to defraud the system in order to obtain benefits they are not allowed to get. In a cross border context national problems are being exported within the EU. A fraudulent patient in his own member state is likely to do the same in a foreign country. Likewise when a provider is doing something fraudulent in his country they will likely do the same with foreign country if they feel the opportunity exists to take advantage of the system.  So as such we consider this already to be a problem and one which will grow in relation to cross border healthcare.

Individual patients will abuse the system through identify fraud, by trying to obtain treatment by using the identity of someone who is entitled to that treatment because they themselves have been denied treatment or medication within their own country.  Sometimes the patient is not an EU national and is using a stolen identity in order to fraudulently gain treatment. There have already been cases of patients travelling from Belgium to the Netherlands using the EIIC insurance cards in order to obtain medicine they are not entitled to in their home country.

How is the EU combating supplier fraud?

The individual suppliers that commit fraud will probably be doctors who can no longer practice in their home country who will move to another EU country and set up there.  They may have been struck off and patients will have to deal with practitioners who will by trying to defraud the system.  Currently no EU-wide system exists that enables patients or organisations to obtain reliable information on a foreign doctor’s fitness to practice and there are huge discrepancies throughout Europe around the doctor registration.  In fact the UK and Nordic countries are much more advanced in doctor registration of healthcare providers than many other countries in Europe.

Many people are aware of that problem and a working group established called “Healthcare professionals crossing borders”.  The GMC are coordinating this and the GMC working group is trying to set up a system with a template providing at least minimal information on healthcare providers moving abroad.

How is the EHFCN involved in trying to stamp out fraud and corruption in the numerous EU healthcare systems and entities?

My organisation exchanges as much info as possible between bodies involved in order to help counter healthcare fraud and corruption and aim for transparency across the EU. We are setting up warning systems but one of the main problems is public perception. When looking at medical travel there is currently no transparency of information and as a result patients don’t really know where they end up or what they are getting. It is very hard for patients to find out information about doctors, qualifications and clinical standards when researching treatment options abroad. That’s why we sympathise with Treatment Aboard which is trying to set up patient information systems to help patients make choices based on reliable information that has been monitored by an independent third party. Going forward, the whole procedure has to be secured across the EU at the very least and the EU needs to put into place certain initiatives that will enable and ensure a reliable exchange of information between member states on all aspects of healthcare and its providers.

Does the EFHCN work with the EU and individual member states on anti-fraud initiatives?

It is our duty to make sure that governments are made aware of the fact that a lot of their money is lost due to fraud and corruption.

One of goals is to raise levels of integrity within the healthcare community by increasing awareness about what constitutes fraud and corruption in healthcare and the levels and the extent of it.  An increase of awareness will enable us to destabilise the dishonest minority at both individual patient and provider level.   To this end we have been working together with Transparency International and the Council of Europe and have been involved in drafting recommendations on good governance in healthcare which will put instruments of fraud prevention into place and which is being approved this week in Brussels.

Who are your members?

80% of our members are Government bodies and others are private insurers. My objective as President is to have a highly diversified set of members. Everyone who works in healthcare should be concerned and aware of the extent of fraud and corruption in healthcare and needs to be involved in preventing and eliminating it.  It’s not only the governments who should be a member of our network. Healthcare care providers and patients have an interest too.

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