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Hand in hand against fraud

1 November 2018

Protecting your health plan

The customised cover your organisation provides reflects its willingness to ensure adequate medical care at a reasonable price for your employees. Unfortunately, some health care providers and even plan members may misuse this protection by submitting false or inflated health care claims. The person committing fraud may receive the financial benefit, but in the long run all plan members lose out due to increased plan costs or benefit limits. Fraud prevention is also of crucial importance to you, due to the significant financial impact it can have on your organisation. To this end, we have an anti-fraud policy aimed at prevention, detection and investigation.

The facts on fraud

  • According to a report by the EHFCN, European Union countries spend more than €1 trillion a year providing health care. But health care fraud is costing budgets €56 billion in Europe and €180 billion globally.*
  • Losses due to fraud can be between 3% - 8% of the total health care budget of an organisation.*

Detecting fraud
You can pre-empt the costs for your organisation. But when it comes to health care fraud, it’s hard to predict how much it will cost if it happens. Countering fraud effectively reduces these losses and frees up resources for better patient care. Some examples of fraud that we encounter are:

  • Health care providers knowingly billing for services and/or supplies that were not provided, or for more expensive services than those provided.
  • Patients claiming for excluded health care costs they are not entitled to.
  • person claiming using another patient’s membership card to access medical care, supplies or equipment.
  • Fabrication of invoices by a plan member, or colluding with a provider to create false invoices.

The actions we take fall into 4 areas:

  1. Creating fraud awareness amongst our staff
  2. Establishing a general control environment
  3. Developing specific measures for fraud prevention and pre-payment fraud detection
  4. Developing specific measures for post-payment fraud detection

Can you reduce your organisation’s fraud costs?
Increasing fraud awareness amongst your employees is an important step. Why not launch an awareness campaign for your organisation? Our investigation unit can help you with this, ask your Client Manager for more details.

If one of your employees informs you that he or she suspects fraud, they can report it to us using the fraud report form on their personal webpages or by calling our hotline on +32 32 176 871. We guarantee strict confidentiality and a thorough investigation of all reports received.

*Gee, J., Button, Mark and Brooks, G. (2010) The financial cost of healthcare fraud: what data from around the world shows.