Unfortunately we, in our capacity of healthcare insurer, also have to deal with fraud. Examples are when an insured or healthcare provider submits an invoice for healthcare that was never actually provided. As an insured person, this may affect you. When a lot of healthcare expenses are wrongfully claimed, it may result in higher healthcare insurance premiums. An active fraud policy is therefore vital.
What do we do when we suspect fraud?
In the event of threatening behaviour, we can document the personal data of a healthcare provider or insured in the External Reference Index (”EVR”). This is done in accordance with the rules set out in the Protocol Incident Warning system for Financial Institutions (PDF). The EVR is used by financial institutions to assess the integrity of customers and business relations. We can assess the EVR via the central database of the Central Information System Foundation (CIS).
What do we do in the event of fraud?
If we suspect fraud, we may have the details recorded in the Fraud Information System Holland (Fraude Informatie Systeem Holland) (FISH) or other fraud identification systems recognised by the insurers. Data is recorded in accordance with the rules set out in the FISH Protocol (PDF).
Want to report suspected fraud?
You too can help to reduce fraud. Do you feel a healthcare provider has invoiced treatment he never provided, or do you have doubts about the amounts or treatment times invoiced? Visit the website of Eno, the parent company of HollandZorg, to find out more about our fraud policy and the measures we take when fraud is confirmed.
If you have any questions about our fraud policy, please send an e-mail to firstname.lastname@example.org. You can also use this e-mail address to report suspected fraud. We will of course treat the information provided by you in confidence.