Fraud in healthcare is reprehensible. Available healthcare money should go to those citizens who really need care and no one else. That is why KNMG understands the need to be able to investigate suspicious money flows. But the new bill on 'legitimate care' unnecessarily undermines medical confidentiality and the social interest it protects.
On July 5, KNMG responded via an Internet consultation to the bill "Promoting Cooperation and Lawful Care Act. Among other things, the bill requires municipalities, health insurers and Wlz administrators to share patient data with each other. Doctors provide this medical data to municipalities and health insurers in order to declare the care they provide. The bill requires those recipients to actively share this confidentially provided data with each other and use it in fraud investigations. The said parties and supervisors and inspection and investigation services will also be required to share the data with the government's Healthcare Fraud Information Exchange. There will also be a "Healthcare Warning Register," which is designed to exchange data on known fraudsters with each other.
Disproportionate
The KNMG previously established the Independent Expert Physician (ODA) as a buffer in for situations where there is a criminal investigation into healthcare fraud. Then patient data remains protected. An ODA acts as an intermediary in criminal investigations into healthcare fraud, thus preventing the judiciary from needing access to data from a medical file relevant to the investigation. The KNMG notes that since its launch in January 2017, not one ODA has yet been called upon. The KNMG therefore strongly questions the need for this bill. The KNMG would first like to see substantiation showing that the extent of healthcare fraud is still so great that it justifies rigorous measures such as a legal breach of medical confidentiality.
Societal interest
An individual doctor cannot prevent the patient information supplied to him from soon being used for fraud investigations. However, he can be expected to experience consequences of this in daily practice. Patients know that their medical information with the doctor is no longer protected and may no longer feel free to tell their doctor everything. They may withhold information, request that their data be destroyed or even avoid care. This has bad consequences for healthcare in the Netherlands and public health in the longer term. It is therefore vital that we prevent unnecessary breaches of medical confidentiality.
KNMG in discussion with VWS
The Ministry of VWS is now processing responses to the draft bill through the Internet consultation. The KNMG is still in talks with VWS to explain its response to the Internet consultation.
