Oversight of healthcare providers and investigation of healthcare fraud
That happens at two points: before a contract or an authorisation is in place, and during its term when a signal comes in.
For the Wmo 2015, the Dutch Social Support Act, oversight of quality and lawfulness lies with the municipality, with the powers that the Algemene wet bestuursrecht, the Dutch general administrative law act, gives a supervisory officer. Under the Jeugdwet, the Dutch Youth Act, quality oversight lies with the IGJ, the Dutch health and youth care inspectorate, while the municipality supervises lawfulness and efficient use. When the unlawfulness is intentional it is healthcare fraud, and stricter requirements apply to what you must be able to demonstrate. That oversight covers both providers under contract and providers working through a personal budget (pgb).
A provider that supplies only Wmo support falls outside the Wtza, the Dutch healthcare providers market-entry act, altogether: no notification duty and no permit requirement. The IGJ does not supervise it either, because the Wtza and the Wkkgz, the Dutch care quality and complaints act, use the same definition of care and Wmo support sits outside it. If that same provider also supplies care that does fall under the Wkkgz, both of those cease to hold.
That does not make the municipality the only party looking. Since 1 January 2025 the Wet bevorderen samenwerking en rechtmatige zorg, the Dutch act on cooperation and lawful care, obliges every municipality to connect to the Informatieknooppunt Zorgfraude, the national healthcare fraud information hub, and provides the legal basis for the healthcare fraud warning register. That register is not yet in use. What does exist is the duty to share signals, and with it the chance that a provider was already known elsewhere.
Wmo 2015 and Jeugdwet
Contracting and proactive oversight
Bibob at authorisation
Monitoring during the contract
What must be in place at the end
Established unlawfulness is not yet a ground for recovery. Article 2.4.1 of the Wmo 2015 sets an intent requirement for that, and where a care provider is held liable as well, the requirement applies twice: to the client who supplied incorrect or incomplete information, and to whoever knowingly cooperated in it. The burden of proof lies with the municipality.
Intent is not a finding that follows from a single document. It has to emerge from what happened when, and from what those involved knew at the time.
The oversight report rarely stays behind closed doors either. The provider receives the draft and may submit its views, and many municipalities publish the final report.
In Noctua you can establish, for every finding, which source it came from and at what moment. Documents are filed by investigation and by entity, without you having to keep up that arrangement yourself. Material that stays out of the report remains available in the file.
Lawfulness investigation and claims
A lawfulness investigation turns on whether the care that was paid for was actually delivered. That is a different question from whether the care was good, and the answer comes from different material: claims, hour records, rosters, and what the client says they received. Those documents regularly contradict each other.
In Noctua they sit together in one file, each with its source and the moment it came in. If you later have to explain what a recovery rests on, that is where it is.
Providers working through a personal budget
With a personal budget (pgb) the care agreement is between the budget holder and the provider, not between you and the provider. That changes the contractual route, not the question you have to be able to answer.
What makes pgb investigation distinctive is that the same provider turns up with several budget holders. Each case stands on its own, but the provider is the same entity. What you established about that entity in one case is there when it appears in the next.
Where Noctua fits in
What shapes the investigation are the sources your organisation may query and the rules you set yourself. That holds for every moment at which you look at a provider.
At contracting, you map out who is behind a provider before an agreement is in place. A healthcare provider is often backed by more than one legal entity, and control does not always run through the party that signs.
In proactive oversight you decide yourself on what grounds you select a provider. Why this provider and not another is a question you can be asked afterwards, and that ground is in the case file with the moment alongside it.
When a signal comes in, that investigation starts in the case file that already holds the earlier assessment. What you established before is still there, and you see straight away what has changed since.
What changes in the meantime
A contract continues and a provider changes. A new director, a changed structure, an insolvency at an affiliated company. You decide for yourself which providers you continue to monitor and what you want to be alerted to.
That notification lands in the existing case file, alongside the assessment already there. Monitoring belongs to the case file and disappears with it.
You record the grounds for going deeper
Which grounds lead to further investigation is recorded by your own organisation: at contracting, in proactive supervision, and when a report comes in. We set those grounds up together with you.
The Wet Bibob applies here too
When authorising healthcare providers, you can start a procedure under the Wet Bibob, the Dutch public-administration integrity screening act, to assess integrity. You can also request a VOG (certificate of good conduct) for the legal entity, the director and the internal supervisory body. If a provider does not meet the requirements, that can be grounds to refuse or withdraw authorisation.
If your organisation carries out that procedure, it is the same investigation as for a permit or a subsidy.
The Wet toetreding zorgaanbieders, the Dutch act on the entry of healthcare providers, adds a notification duty for new providers and a licence requirement for part of the institutions. That licence too can be refused and withdrawn. A Bibob procedure at authorisation is the same integrity investigation as for a permit or a subsidy, with the same evidence underneath.
Bring a provider you got stuck on
We build a case from your own practice in the platform, including the audit log that accumulates behind it. We then go through which sources you may query and what triggers further investigation under your own frameworks.