Know who you're hiring
The best way to tackle fraud is to ensure it doesn't cross the threshold of your institution. A thorough Pre-Employment Screening (PES) is not a luxury in the healthcare sector, but a dire necessity. Before a new employee, medical specialist, or freelancer gains access to your medication depots or stands at your patients' bedside, several things must be crystal clear:
- A Certificate of Conduct (VOG) can be forged. It is crucial to verify its authenticity and check the current status in the BIG register, proactively looking for (conditional) suspensions or disciplinary measures.
- Unfortunately, the trade in fake healthcare diplomas is increasing. Don't settle for a PDF file; verify directly with educational institutions and official registers whether a candidate has actually and successfully completed their training.
- In-depth reference checks with former employers and targeted integrity interviews often reveal the true employment history and moral compass of your future employee.
Six types of healthcare fraud we encounter in practice
Despite stringent gatekeeping controls, things can still go wrong internally. Healthcare Fraud is often cleverly concealed in the administration and difficult to prove without disrupting critical, daily care processes. These are the most high-risk scenarios that investigators encounter in practice:
1. Theft of medication and opiates
Unexplained inventory discrepancies in a pharmacy's medication depot or your nursing home's medication carts are a red flag. This often involves the embezzlement of strong painkillers and opiates, such as morphine or fentanyl. Motives range from personal use and addiction to lucrative resale on the black market.
2. Forged diplomas
When employees or freelancers perform complex medical procedures with forged VIG or Nursing diplomas, or tamper with their BIG registration, it creates life-threatening situations. Besides the risk to the patient, it exposes your organization to enormous legal liability.
3. Patient record fraud and time sheet fraud
Especially within intramural care, administrative manipulation is a persistent problem. Time sheets may suggest full staffing, but in reality, one heavily burdened flexible worker covers the entire shift on a closed ward. Patient files are retrospectively made administratively sound to maintain the appearance of quality for inspectors.
4. Misuse of Personal Budget (PGB)
Through PGBs, we regularly see sophisticated misuse of healthcare funds. Unscrupulous care providers – sometimes even in collusion with family members – skim budgets for personal gain. As a result, your vulnerable resident or client simply does not receive the care they need.
5. Stacking shifts
A growing problem is the widespread violation of the Working Hours Act. Flexible workers, through various temp agencies, string together full-time shifts at multiple hospitals or nursing homes. The result? Extreme fatigue and an unacceptably high risk of fatal medical errors within your walls.
6. Absence Fraud
Absence Fraud is costly and frustrating. Consider a nurse who reports long-term sick leave due to severe burnout symptoms, but during this paid period, is found to be underhandedly working at full capacity in another hospital. This directly impacts your team and the quality of care.
From suspicion to conclusive independent evidence
If you suspect one of these scenarios is unfolding within your organization, caution is advised. Internal investigations require utmost care to prevent reputational damage in the media and to avoid unnecessarily straining workplace relationships.
An fact-finding investigation is always conducted carefully and with integrity, within the bounds of the law. The outcome is an objective, certified report that serves directly as a watertight legal foundation for your next steps, such as employment law sanctions or a report to the Healthcare and Youth Inspectorate (IGJ).
Protect your healthcare organization
Integrity violations never resolve themselves. They cost money every day and undermine your healthcare capacity. Are you encountering irregularities within your hospital, nursing home, or pharmacy? Intervene promptly with an independent fact-finding investigation and have your suspicions confidentially assessed by experts.
