Open House
Open House in Norway concludes with key words of transparency and trust
Participants from several EU countries attended the EHFCN-HELFO Open House, organised and hosted by member organisation HELFO in Oslo on 11-12 May. They came to listen to Norway's strategy and methodology to fight against healthcare fraud from the perspective of HELFO, the Norwegian Health Economics Administration, a sub-ordinate agency directly linked to the Norwegian Directorate of Health.
HELFO ensures that approved policies are implemented in the healthcare area in accordance with guidelines issued by the ministry. It is a.o. responsible for the direct payments to various health service providers, i.e. general practitioners, medical and para-medical specialists such as physiotherapists, chiropractors, speech therapists. The organisation also reimburses expenses related to treatment, medicines and materials for private individuals, including healthcare services provided abroad, and administers the issuance of the European Health Insurance card. Hospital care and reimbursements however are not of HELFO's responsibility.
After a general overview on Norway's healthcare system, on Norway's link with the European Union, particularly on the issue of healthcare, and on HELFO's work areas and responsibilities, the audience listened to HELFO's risk and compliance process, to its control strategy and risk management, as well as to its risk assessment and risk matrix. All presentations are available to members on the extranet of the EHFCN website.
Concrete cases and examples given on the second day helped participants better understand the system and HELFO's way of working. The presentations concentrated on detection, particularly on the control of dentists and physiotherapists, and on the investigation, sanction and prosecution as carried forward by HELFO. Interesting was the fact that errors and abuse can be detected before reimbursements are made, allowing HELFO not to go through the lengthy and resources demanding procedure of claiming back money. Their automatic rejection and control system (Kuhr) allowed for example to easily find duplicate claims (f.i. two doctors working in the same office claiming to have seen the same patient at the same time) or cases where the doctor was the patient or a relative of the patient. Two cases of a physiotherapist and of a GP were brought forward.
Trust and transparency in tackling errors, fraud and abuse appeared to be keywords to the rest of the international audience, as indeed trust is applicable throughout any control process and prevention is focussed on at all levels, from risk management and detection to sanction. Trust is further reflected in the sanctions pyramid in which sanctions escalate very mildly compared to other countries and settlements are aimed at with each step. Yet these are still strong and effective. Only when confronted with a criminal act does HELFO have the power to report to the police, who is then responsible for the investigation. It was reminded that the healthcare and social security sector has a lot of money, that organised crime should be tackled and that the Network should denounce it.