Response to interpellation 2023/24:267 on welfare crime within healthcare
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
KD argues that the government is working broadly to combat welfare crime and takes a serious view of unserious actors within healthcare 1. KD emphasizes the importance of balancing protection against criminals with not creating difficulties for serious actors 1. KD notes that regions and municipalities have a statutory responsibility for control 2, admits that sufficient action has not been taken previously 2 and is working on grounds for exclusion as well as a register of healthcare and care providers 2. V argues that criminal networks enter the welfare sector to launder money 3. V advocates for a stop law 4, licensing requirements 4 and national crackdowns 4.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! Karin Rågsjö has asked me if I intend to take measures to curb criminal welfare activities within healthcare based on the proposals received from, among others, the Health and Social Welfare Inspection, Ivo, and the Swedish Association of Local Authorities and Regions, SKR. Karin Rågsjö has also asked me if I intend to limit the new establishment of private companies within healthcare to prevent criminals from conducting activities. Finally, Karin Rågsjö has asked me if I intend to strengthen Ivo's supervisory work so that the authority can expand the scrutiny of unscrupulous actors within healthcare.
The government is working broadly to combat fraud and welfare crime and views the reports that unserious actors are establishing themselves within healthcare very seriously. We see a growing problem with unserious and criminal actors within, for example, dental care, health centers, and aesthetic businesses. Much indicates that these crimes against welfare have become more systematic and advanced, in some cases even cross-systemic.
The Government and relevant authorities and actors are working together to stop welfare crime. In order to identify effective and concrete measures, a thorough analysis of the situation is being conducted within the Government Offices. And the proposals are currently being prepared within the Government Offices.
Care providers are obliged to follow applicable law and must be able to guarantee patient safety, regardless of whether healthcare is provided in a public or private capacity. The Government is considering various measures that can limit criminal actors' opportunities to establish themselves within welfare. It is important to achieve a balance between the interest of protecting welfare from criminal actors on the one hand and avoiding unnecessary difficulties for serious actors to establish themselves and operate healthcare activities on the other hand.
IVO carries out supervision, examines issues regarding complaints, and conducts permit reviews. The purpose of the supervision is to review that the population receives care and nursing that is safe, of good quality, and conducted in accordance with laws and other regulations. Through this mandate, IVO has an important role in preventing and counteracting welfare crime within healthcare and dental care. Within the scope of its supervisory mandate, IVO has the authority to prohibit operations within care and nursing and revoke permits, so that unserious or criminal actors are not allowed to continue operating. Even when it concerns operations that are not covered by permit requirements, IVO can hinder unserious actors through its supervision of compliance with provisions on, among other things, quality, patient safety, and competence.
The Government is keen that Ivo is given the necessary powers and has therefore, among other things, decided on supplementary directives, dir. 2023:32, to the Treklöverutredningen, S 2021:09. The investigation shall also analyze and propose how the Medical Products Agency, the Dental and Pharmaceutical Benefits Agency, and the Health and Social Services Inspectorate can be given expanded opportunities to exchange data during supervision of the pharmacy market. The assignment shall be final reported by December 31, 2023, at the latest.
The Government has taken a number of measures in the work against welfare crime. Several authorities have been given assignments within the framework of that work.
For example, the National Board of Health and Welfare has been given a mandate to map out which areas and types of activities are particularly vulnerable, as well as to support municipalities and regions in the work regarding welfare crime in health and medical care and propose measures, S2023/03096.
Regarding the work within dental care, Socialstyrelsen has a mandate to assess the conditions for introducing a national model for risk assessment within dental care, S2023/01524. Furthermore, Socialstyrelsen, together with Försäkringskassan, has had a mandate to strengthen the control over the state dental care support, S2022/03250. Additionally, Försäkringskassan and Ivo have had a mandate regarding reinforced cooperation regarding control, follow-up, and supervision of dental care actors, S2022/03249. Finally, Tandvårds- och läkemedelsförmånsverket has a mandate to carry out an information initiative to strengthen dental care patients, S2023/02104.
The investigation on strengthened support for dental care for victims of violence and increased control over the dental care sector, S2022:12, has submitted the partial report Increased control over the dental care sector, SOU 2023:82. In the report, it is proposed, among other things, that a permit requirement and ownership and management screening shall be introduced for private healthcare providers, which in the long run can make it more difficult for criminals to operate within the welfare sector. The report will now be subject to a referral process. But since the work to stop welfare fraud is prioritized, the proposals in the report will be analyzed and prepared within the Government Offices in parallel.
In the 2021 investigation into benefit fraud, S 2021:03, the partial report Strengthened work to combat benefit fraud - administrative sanction system and more efficient handling of suspected crimes, SOU 2022:37, proposes, among other things, an administrative sanction system for less serious benefit crimes and for incorrect payments caused by the individual. Preparation is ongoing within the Government Offices. In the investigation's final report A strengthened and unified protection of the welfare systems, SOU 2023:52, a system with a benefit ban is proposed, among other things, for those who are convicted or issued a summary order for so-called benefit crimes of the normal degree or gross benefit crime. The final report is being processed as a referral, and a referral meeting on the proposal for a benefit ban has been held with a selection of affected authorities.
Finally, the government has also decided on the bill A new data protection regulation in the social insurance area, prop. 2023/24:29. In the bill, it is proposed that the purposes for which Försäkringskassan and Pensionsmyndigheten may process personal data be expanded so that the agencies may process personal data if it is necessary for control measures. The proposals also enable an increased exchange of information, among other things to support the agencies' control work.
Karin Rågsjö (V)
Mr. Speaker! I thank the Minister for the answer.
One might wonder if there is a mafia in Sweden. I would probably answer yes to that question.
The Economic Crime Authority warns that the gangs' largest source of income is no longer drugs but welfare crime. They run health centers, manage vaccinations, and take care of young people in risk zones.
It is about criminal networks that are entering the welfare system. Do we know what is going on? No, not really. Is it extortion? Is it infiltration? These are questions that we believe one must drill into.
The welfare construction that has freedom of establishment with minimal control contributes to an increase in welfare crime. I believe that the welfare system is under attack. Criminals make profits from the common tax funds by conducting these activities within the welfare sector. It is also a way to extract profit from tax money and launder money from criminal activities.
That organized crime has infiltrated the common welfare also involves losses in the billions and threatens people's most immediate security and health in contact with just health centers, vaccination centers and so on.
In the long run, this is a threat to the welfare system itself, the rule of law, and democracy. This is a serious issue.
On October 10, Minister for Health and Care Acko Ankarberg Johansson, together with Minister for Social Services Camilla Waltersson Grönwall, met with Sveriges Kommuner och Regioner, Socialstyrelsen, Inspektionen för vård och omsorg, Ivo, and Ekobrottsmyndigheten for a conversation about these unserious actors in the welfare sector. That is good. But we mean that the ministers need to do very much more. Now there are investigations underway. We think that is good – that things are happening.
But for example, Ivo, who receives additional directives, also needs funds to act in this direction. It is extremely important.
We have for a long time from Vänstern pointed out the serious consequences of relinquishing control over healthcare and other welfare to private actors with minimal oversight. And that criminal networks are now, judging by everything, taking this chance to make money and that laundering money within the system is quite logical. We believe that freedom of establishment is a gold mine for the criminal networks.
We have criticized this development for quite a long time, but it has been allowed to continue unhindered. From having been primarily driven in own management, the welfare sector was opened up to very many private actors. In a recently published report by Carina Gunnarsson within the framework of SNS's research project Crime and Society, the very deficient impact analysis regarding opening the welfare sector in this way is also highlighted. One might think that nothing should happen – one might think that people are good – but there are always forces that can find their way in.
I believe, Mr. Speaker, that Minister Acko Ankarberg Johansson has not fully clarified what should be done. Should we not try to limit the establishment of private companies within health and medical care in order to curb this before we face an even greater problem than now? I simply find no answers in this.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! I thank the member again for raising the issue. This is an issue that is on my agenda almost every day – that measures are needed and what measures we take. I have had many meetings, not just the ones the member refers to. It has been necessary for many actors to see this picture.
We have since continued in discussions about measures. I believe that for quite some time we have thought that what we are to handle is fraud and negligence, that is to say that someone bills too much or thinks that one is paid too little and does a bit extra. That is one thing – and all of it is wrong – but what we are dealing with now is criminality where one hasn't even intended to enter the healthcare system but simply uses it to wash black money white or to finance their criminal activities. It is, therefore, two completely different things.
Municipalities and regions already have responsibilities according to the Local Government Act. In Chapter 10, Sections 7-9 of the Local Government Act, it clearly states that one must have control over and follow up on everything one delegates to someone else. If the member refers to health centers specifically, one of the laws that applies, in addition to the Health and Medical Services Act and many others, is the one on choice systems. It is stated there that one must fulfill the requirements. One must establish specific contractual conditions, and one must follow up on them.
Every region thus has this as a statutory obligation, but I believe they have focused on fraud and negligence and missed that it could instead be criminal activities that it is about. I would, of course, have wanted the regions to have taken that into account, but I also understand that they have not been there.
An area where we have seen this before has been the assistance, where crime entered early. During 2015 and 2016, when we needed many HVB homes for care and housing for not least unaccompanied refugee children, we needed places. We know that operations were then opened that were not intended for what they were doing but were part of criminal activity.
We have also seen many examples in dental care, where Ivo has already been involved and conducted supervision regarding these problems. We also saw it during the pandemic, when the testing activities became an area where criminals simply stepped in to earn money to finance their operations or to launder money. We have also seen it within aesthetic activities - and now we see that it also exists within healthcare.
The Chairman is therefore completely right that this is a long development and that it really has not been done sufficiently, neither from the regions and municipalities nor from the state's side – if it had, we would not be where we are. It is necessary that we take action now.
There are several regions that are really taking action on this. Region Stockholm and Västra Götalandsregionen have had a good operation for a period, and now Skåne has also started. Halland is joining this, and Östergötland and Uppsala are in the works. So, one is indeed taking this up, even though it is clear that it should have happened a long time ago, one is in the works. I am very happy about that.
When it comes to what the government is doing, we are working together across very many different departments. This concerns not only the Ministry of Social Affairs but also many others, and I am pleased with all the cooperation we have. We need, for example, to clarify grounds for exclusion; these are already included in the laws on choice systems, but they need to be clarified. A short while ago, we received a good basis from the Supplier Control Inquiry, which is now undergoing a referral process. We therefore have something to work with.
In my department, we started as early as this summer to establish a register of healthcare and care providers, which has been completely missing. We haven't even had control over who exists. We have also recently, as mentioned, tasked Socialstyrelsen with mapping out the activities and seeing what we need to do. I am also awaiting an important response from Sveriges Kommuner och Regioner, who have promised to come back with a petition and a list of measures next week, or if it is this week – it is a bit unclear. It is important for us to receive a formal request regarding how the regions view this. In other words, we will get back to you.
Karin Rågsjö (V)
Mr. Speaker! I think that national action is needed here. The 21 regions should not have to do their own thing in this, but I believe there must be some kind of framework around this. Stockholm has just started to take back operations that have not fulfilled their duties, if I may put it that way.
On November 16, we had a meeting in the Committee on Social Affairs and met with very many actors. We met SKR, Ivo, the police, the Swedish Economic Crime Authority – everyone who is involved in this. They put very many proposals on the table on how to prevent those actors who are clearly unsuitable. It was about permit requirements, increased resources for the supervisory authorities, and much more.
I return to the fact that we have for a very long time proposed that criminals should be prevented from starting welfare activities within health and medical care through a prohibition law. It is about preventing private actors who do not have clean hands from being able to operate within these activities.
Sveriges Kommuner och Regioner purchased services for 194 billion SEK from private actors in the welfare market in 2021. These are services that actually should have been performed in-house. This constitutes approximately 17 percent of the sector's total costs, which is an enormous amount. In 2023, the Swedish Economic Crime Authority, together with other agencies, published a situation report, and in it it turns out that they expect approximately 9 billion to go towards economic crime where different types of operations have been opened within specifically healthcare, dental care and so on. The dark figure is also large. It is a crazy amount of money that disappears into black holes.
I believe that politicians for a very long time have put themselves on their knees to the market without thinking about the consequences. We think this is a very important issue. It is still the case that these criminal networks, which I call the mafia, extract very much money from the systems. It is of course very bad. It is also about me being able to go to a health center that, so to speak, is not controlled by mafia-like organizations.
Amir Rostami said: "Narcotics have been central to organized crime and we have had tunnel vision. This has caused us to miss other parts of the criminal gangs' sources of income." He is a professor of criminology, and he points out precisely the fraud crimes and welfare crimes, which are escalating. This is a market that is growing, that is, the illegal one where one can make large sums of money from tax money but also by laundering clean money.
I am also thinking of the children who came here as unaccompanied minors and the children who are now being placed in HVB homes. This is not the government's responsibility, but a criminal network infiltrating an HVB home obviously has an extraordinarily good recruitment base there. I believe there are several examples of this. Completely different guidelines are needed here.
I wonder, Mr. Speaker, if the Minister intends to strengthen Ivo's supervisory work so that the authority can exercise an even stricter scrutiny of these unserious actors. Will there be a powerful increase in resources? I see with concern that the regions, now that they have enormous deficits, will hardly have the resources to follow up on this type of super-problem in their regions. Instead, everything will be invested in trying to ensure that we get a healthcare system we can rely on.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.