GP in Trouble for Making Unjust Claims on Corona Tests

This is evident from the judgment of a summary judgment that the GP brought proceedings against CZ. He claimed more than 157,000 euros from that health insurer alone for more than five thousand corona tests in people who were not registered in his own practice. The so-called ‘passer-by rate’ may only be charged if a GP actually sees a patient from another practice for a consultation. But this was not the case with these corona tests – which were not administered by the GP himself.

When CZ discovered, after two reports from insured persons, that the GP still claimed the passer-by rate for the corona tests, the insurer started an investigation. CZ thought there was sufficient reason to include the Weesp GP in the fraud register, which can also be consulted by other insurers and financial institutions.

For example, the GP who had opened the test street to ensure that patients in the region could safely visit their own GP was suddenly known as a fraudster. A bitter pill: the GP was even named ‘Orphan of the Year 2021’, as a reward for all his efforts. He was also under the assumption that he was allowed to declare the costs of taking the tests.

That is why the GP initiated summary proceedings, in which he demanded that CZ remove him from the list of fraudsters. He feels his good name has been damaged, and because he is in the suspect’s bench, he gets into trouble with other health insurers, for example because the payment of other claims is delayed.

The summary proceedings against CZ were filed two weeks ago, the verdict was published on Wednesday. This is not favorable for the doctor. CZ was in its right when it placed the doctor from Weesp on the fraud list, says the judge in preliminary relief proceedings, because he simply made unjust claims on a large scale. The doctor’s demands have been rejected and he must also reimburse the insurer’s legal costs.

However, the judge also takes the case somewhat for the general practitioner. He made a mistake at the time of “the chaotic developments that occurred during the corona pandemic.” It has also not been shown that the doctor has not acted with integrity in other areas, the judge said. He also made no attempt to disguise his conspicuous expense behavior, knowing that it would be noticed by CZ.

Lawyer Geertjan van Oosten, whose office assisted the GP in the summary proceedings, therefore sees the judgment as proof that his client is not a fraudster. “We therefore find it a somewhat strange statement.”

The GP has already indicated that he is prepared to refund unjustly submitted claims. “We will discuss this with CZ,” says Van Oosten. “We hope that we can work it out together.”

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