Countries must tackle fraud and corruption in health tourism

100 delegates from 16 countries representing ministries of health, sickness funds, healthcare providers and other parties committed at the European Healthcare Fraud and Corruption Network (EHFCN)'s Annual Conference to strengthen co-operation in their fight against healthcare fraud and corruption.

Centered on the theme of “Cross-Border Healthcare in Europe ”, the conference discussed possible consequences of the draft EU directive 2005/36/EC-giving patients and practitioners the right to free movement throughout member states.

Paul Vincke, president of EHFCN said, “Although EHFCN supports patients and healthcare providers mobility, we also warn decision makers of the risks of increased fraud and corruption in this sector. We call on them that provision is made to reduce losses to a minimum. We also look forward to implementing solutions that were advanced at the conference. An estimated 80 billion euro is lost to fraud and corruption in the healthcare sector every year. Let us eliminate fraud for the benefit of healthcare systems in Europe and the ultimate benefit of every patient".

Cooperation between member states and between healthcare parties is perceived a key to successfully tackling cross-border fraud and corruption. Sharing information is vital and can be started on a small scale between neighbour countries. An example is the bilateral cooperation agreement between the French health insurance fund for salaried employees (CNAMTS) and the Belgian National institute of disability and health insurance (INAMI/RIZIV). The purpose of this agreement is to facilitate the quick exchange of files and information in order to improve research and investigation. The agreement will take effect in 2010.

An important tool to assess risk and outline issues and contributing factors affecting fraud was presented by members of the EHFCN Cross-Border Fraud Working Group. The matrix is designed to identify the most important obstacles that member states are likely to encounter in their work of prevention, detection and sanctioning of fraud. It is particularly intended to be used in a cross-border context, taking into account that member states have different healthcare and legal systems.

The matrix helps to analyse the types of fraud that can derive from specific risk factors such as legal loopholes or lack of access to information or treatment, for every party involved (governments, practitioners, patients, insurers).

Representatives shared their experience and best practices in tackling fraud and corruption. EHFCN also conferred its first Excellence Award on Ewa Kopacz, Minister of Health for Poland, where tangible progress has been made towards an anti-fraud and anti-corruption culture within the Polish healthcare system, thanks to her continued efforts and determination.

The European Healthcare Fraud and Corruption Network (EHFCN) was established in 2005. EHFCN is the only European organisation dedicated to combating healthcare fraud and corruption across Europe in order to bring back money to healthcare services for the benefit of every patient. EHFCN provides information, tools, training and assistance in fighting fraud and corruption to its member associations. It also offers a platform for members to exchange information and ideas.

The matrix proposed by the Cross-Border Fraud Working Group is based on the Enterprise Risk Management-Integrated Framework (COSO ERM Framework). The framework provides a solid foundation that can be used by companies to enhance corporate governance and deliver greater stakeholder value.

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Source: European Healthcare Fraud & Corruption Network (EHFCN)