Diederik Schrijvershof and Jeanne Plettenburg have successfully filed an enforcement request with the Dutch Healthcare Authority (“NZa”) on behalf of an association of healthcare providers. That enforcement request was made in response to several breaches by healthcare insurer VGZ of the NZa Transparency in the Healthcare Procurement Process Regulations (the “Healthcare Procurement Regulations”). The NZa recently found that VGZ was indeed once again breaching those Healthcare Procurement Regulations. On that ground, the NZa imposed fines in the total amount of €100,000 on VGZ. In the NZa’s opinion, the changes made by VGZ to its 2020 procurement policy and its healthcare procurement procedure are in breach of Article 7 of the Healthcare Procurement Regulations. More information on this NZa fine decision can be found here, here, here and here.
Earlier NZa cautions on breaches of the Healthcare Procurement Regulation by insurers
In 2019, the NZa already issued five formal cautions on breaches of the Healthcare Procurement Regulations by insurers. In 2019, the NZa cautioned VGZ (twice), Zorg en Zekerheid, CZ and DSW about established breaches of the Healthcare Procurement Regulations. The NZA had previously fined DFZ (a division of Zilveren Kruis) for breaching the Healthcare Procurement Regulations, more information on hereon can be found here, here and here. In 2019, the NZa repeatedly announced (e.g. here and here) that it would take stricter action against (repeated) breaches of the Healthcare Procurement Regulations. In 2019, VGZ nevertheless turned a deaf ear to the two formal NZA cautions given to VGZ. VGZ again breached the Healthcare Procurement Regulations in 2019, to the detriment of several healthcare providers. It had previously stated, after criticising the manner of healthcare procurement, that aggressive procurement was required. It goes without saying that no matter how aggressive VGZ’s procurement is, it remains bound by the Wet marktordening gezondheidszorg (Healthcare (Market Regulation) Act) and the mandatory NZa rules regarding healthcare procurement and consumer information, and the NZa is effectively enforcing those rules.
NZa Regulations on the provision of information by healthcare insurers
Maverick Advocaten previously also requested the NZa to take enforcement action against VGZ on the grounds of VGZ’s breach of the NZa Regulations on the Provision of Information to Consumers by Medical Expenses Insurers (the “Regulations on the Provision of Information by Healthcare Insurers”). Despite repeated requests, VGZ refused to list certain healthcare providers with which it had recently entered into a contact 2020 in the VGZ zorgzoeker (healthcare finder). As a result, customers of those providers wrongly found healthcare providers listed in the VGZ zorgzoeker as not having entered into a contract with VGZ.
VGZ complains about alleged deception of consumers but itself breaches mandatory NZa rules aimed at preventing such deception
In late 2019, VGZ requested the NZa itself to take action against healthcare providers that criticised VGZ. The NZa then warned healthcare providers on 20 December 2019, without having established any breach, against deceiving consumers, while threatening to impose a fine (of EUR 150,000). By that time andpartly in response to several enforcement requests, NZa was well aware of the indisputable fact that VGZ (despite the two earlier warnings that the NZa had given VGZ in 2019) was again breaching the Healthcare Procurement Regulations to the detriment of healthcare providers. The NZa was also already aware that VGZ itself had demonstrably misinformed VGZ-insured persons and insurance applicants in 2019, in breach of the Healthcare (Market Regulation) Act and the Regulations on the Provision of Information by Healthcare Insurers, for instance regarding the question with which providers VGZ had entered into a contract.
Healthcare providers and insured persons are indisputably inconvenienced and harmed year after year when healthcare providers breach the Healthcare Procurement Regulations and the Regulations on the Provision of Information by Healthcare Insurers. The association of healthcare providers therefore found themselves compelled to request NZa to take enforcement measures. For years now, Maverick Advocaten has advocated adequate mandatory rules (and enforcement of those rules) for healthcare insurers in healthcare procurement and the fighting excessive procurement power of healthcare insurers. More information on this subject can be found here, here, here, here, here, here, here and here. More information on the rights of healthcare providers and the obligations of healthcare insurers can be found at zorgcontractering.com.