Diederik Schrijvershof and Annabel Kingma successfully assisted general practitioners in two proceedings before the Trade and Industry Appeals Tribunal (CBb).
Both proceedings concerned various violations by healthcare insurer Zilveren Kruis (‘ZK’) of the Regulation on transparency in the healthcare procurement process under the Health Insurance Act (‘Healthcare Procurement Regulation’). The general practitioners had requested the Dutch Healthcare Authority (‘NZa’) to enforce the Regulation (see here). The NZa failed to take sufficient enforcement action. The GPs therefore lodged an objection with the NZa and subsequently appealed to the CBb.
In this ruling, the CBb found that ZK had violated Articles 4, 6 and 7 of the Care Procurement Regulation in its procurement of GP care. The NZa had previously, including in its response to the objection, wrongly maintained that ZK had not violated these articles. In this ruling, the CBb confirmed that ZK also violated Article 5 of the Healthcare Procurement Regulation. For example, ZK did not respond in a timely and clear manner to questions and comments from a GP in the context of the healthcare procurement process.
The CBb notes that, in the event of a violation of the Healthcare Procurement Regulation established by the NZa, the issuance of a warning is equivalent to a rejection of an enforcement request. Now that the NZa regularly intends to issue warnings in response to enforcement requests, the CBb's ruling limits this option. This means that the NZa will obviously no longer be able to issue warnings if healthcare insurers continue to violate the Healthcare Procurement Regulation.
The CBb has now shown that much more can be expected from the NZa when it comes to effective supervision of healthcare procurement by health insurers. This is a win for all (primary) healthcare providers. This development does not stand alone. Recently, both the preliminary relief judge in The Hague (see here) and in Utrecht (see here) confirmed, following a plea by Maverick Advocaten, the importance of healthcare insurers complying with the (mandatory) healthcare procurement rules of the NZa.
Maverick Advocaten represents De Bevlogen Huisartsen as well as numerous DBH GPs in proceedings to obtain realistic rates from the NZa (see here and here) and also assists them in enforcing the NZa's enforcement of the healthcare (procurement) obligation of health insurers. In addition, Maverick Advocaten assists numerous other healthcare providers and their trade associations on a daily basis in achieving adequate (enforcement of) mandatory NZa rules for healthcare insurers in healthcare procurement and in tackling abuses of purchasing power by healthcare insurers.
For more information about the rights of healthcare providers in healthcare sales and the options available to their trade associations to support them in this regard, please visit www.zorgcontractering.com.
Follow Maverick Advocaten on LinkedIn
