The Public Prosecution Service (PPS) demands a twenty-month prison sentence against a 51-year-old woman suspected of healthcare fraud. The woman allegedly profited by submitting incorrect claims to health insurers and having them paid out. She is also accused of posing as a general practitioner without any medical qualifications. The defendant undermined the healthcare system and used it as a criminal revenue model, said the public prosecutor.
The investigation into the suspect began in 2019 after the Health and Youth Inspectorate (IGJ) filed a report against her. At that time, she was the director of a general practice in Utrecht. Suspicion arose after claims were submitted to health insurers that were incorrect but still paid out. There is also suspicion that the director posed as a general practitioner for an extended period. She allegedly conducted consultations with patients, provided medical advice, and prescribed medications without a diploma or BIG registration.
Witness Hearing
Investigations by the IGJ revealed that the suspect provided unauthorized care at least in May 2018. Reports of such misconduct were also made in 2017 and 2018. Patients and employees of the general practice who were heard by the police confirmed that the suspect presented herself as a general practitioner. It is noteworthy that the suspects partner also claimed to have been convinced that she had studied medicine. In addition to the witness hearings, the police investigation includes email correspondence regarding observations in the general practice and the submitted claims from the general practice information system to health insurers. This also confirms, according to the PPS, that the suspicions are justified.
Repeated Offenses
After the general practice goes bankrupt, the misconduct continues. This time with the help of a home care organization that the suspect establishes shortly after the bankruptcy, presumably to avoid detection of fraudulent claims. Investigations also reveal that the suspect submits assessments to health insurers and declares costs while no or less home care was provided. The suspect then makes a third mistake by setting up another home care organization, where she continues her misconduct.
Shameless
The prosecutor is clear about the seriousness of the facts. The defendant shamelessly enriched herself with insurance funds intended for the citizens of society, he states. In presenting herself as a general practitioner, both to patients and employees of the general practice, she showed no regard for the unacceptable risks associated with such behavior, said the prosecutor. In determining the sentence request, the prosecutor considers the severity of the facts, the multitude of them, the period over which the facts occurred, and the defendants attitude, who takes no responsibility for her actions.
Weighing everything, the PPS demands a prison sentence of 20 months. According to the PPS, the time the defendant spent in pre-trial detention, 47 days, will be deducted. The defendant is also to receive a fine of €25,000 and a professional ban of 60 months. The ban is intended to prevent the defendant from returning to the healthcare sector after her prison sentence.
The court will rule on March 27.