Diederik Schrijvershof and Jeanne Plettenburg have filed enforcement requests with the Dutch Healthcare Authority (NZa) on behalf of a trade association of healthcare providers. The enforcement requests relate to several violations by VGZ of the NZa Transparency in the Healthcare Procurement Process Regulations (the “Healthcare Procurement Regulations”) and the NZa Regulations on the Provision of Information to Consumers by Medical Expenses Insurers (the “Regulations on the Provision of Information by Healthcare Insurers”).
Healthcare Procurement Regulations
In 2019, the NZa issued five formal warnings for violations of the Healthcare Procurement Regulations by insurers. In that year the NZa warned Zorg en Zekerheid, CZ, VGZ (twice) and DSW on the grounds of violation of the Healthcare Procurement Regulations. The NZa had previously fined DFZ (a division of Zilveren Kruis) for violation of the Healthcare Procurement Regulations. More information on this subject can be found here, here and here. In 2019, the NZa repeatedly stated (e.g. here and here) that it would take stricter action against (repeated) violations of the Healthcare Procurement Regulations. In 2019 VGZ nevertheless immediately disregarded the two formal warnings given by the NZa and again violated the Healthcare Procurement Regulations to the detriment of healthcare providers.
Regulations on the Provision of Information by Healthcare Insurers
Following criticisms of the healthcare procurement process, VGZ has stated that competitive procurement is essential. It goes without saying that no matter how competitive VGZ’s procurement is, VGZ is nevertheless bound by the Wet marktordening gezondheidszorg (Healthcare (Market Regulation) Act – the Wmg) and the mandatory NZa rules on healthcare procurement and consumer information, and the NZa effectively enforces those rules. VGZ requested the NZa in 2019 to take action against healthcare providers that criticised VGZ. The NZa subsequently warned healthcare providers on 20 December 2019, without establishing any violation, not to mislead consumers, while threatening with fines. Partly due to an enforcement request, the NZa was well aware by then of the fact that VGZ, despite its two earlier warnings in 2019, was again acting in breach of the Healthcare Procurement Regulations to the detriment of healthcare providers. The NZa was also already aware that VGZ itself was demonstrably misinforming (prospective) VGZ insured in violation of the Wmg and the Regulations on the Provision of Information by Healthcare Insurers.
Year after year, healthcare providers and insured have been hindered and harmed by the specific violations by healthcare providers of the Healthcare Procurement Regulations and the Regulations on the Provision of Information by Healthcare Insurers. The trade association of healthcare providers was therefore forced to request the NZa to take enforcement measures. Since the specific violations are not only foreseeably harmful to insured and healthcare providers, but VGZ is also repeating its offences, the trade association of healthcare providers trusts that the NZa will now also take timely and appropriate enforcement measures against VGZ.
For many years now, Maverick Advocaten has advocated adequate mandatory rules (and the enforcement of those rules) for healthcare insurers in healthcare procurement and measures against excesses of purchase power of healthcare insurers. More information can be found here, here, here, here, here, here, and here. More information on the rights of healthcare providers and obligations of healthcare insurers can be found at zorgcontractering.com.