Response to interpellation 2023/24:425 on the regulatory framework for pharmacies and health centers
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns the regulatory framework for pharmacies and health centers as well as the fight against welfare crime. S argues that pharmacies and health centers have cheated themselves into millions, which damages trust in healthcare. S believes that better transparency is needed, that corporate groups should not be able to be owned by pharmacy owners 1 and that profit-seeking within healthcare should be stopped because money is disappearing from welfare 2. S demands that the government act to stop criminal organizations 1 and that something is done regarding the system for detecting fraud 2. KD argues that Läkemedelsverket has the primary responsibility for pharmacy supervision 3. KD emphasizes that the government takes welfare crime seriously 4. KD admits that previous governments have failed to handle welfare crime sufficiently well 5. KD believes that more secrecy-breaking provisions and complementary legislation are needed so that municipalities and regions can carry out full audits 5. KD argues that existing legislation is not sufficient 5 and wants agreements to be fully followed up 6. KD prioritizes that every tax krona goes to welfare 6.
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! Eva Lindh has asked me if I intend to act to review the regulatory framework regarding pharmacies and health centers in light of what has now emerged in the media about several pharmacies and private healthcare consultants cheating themselves into public funds by incorrectly requesting reimbursement for medication costs.
It is the Medical Products Agency that has the primary supervisory responsibility over pharmacy operations. Within the framework of its supervision, the agency can, among other things, decide on orders and, ultimately, revoke a pharmacy license.
The irregularities described in the article that Eva Lindh refers to date back a number of years. Since then, the Medical Products Agency has developed its work regarding both licensing and supervision. In the most recent case regarding the revocation of pharmacy licenses, the authority reached a decision within a couple of months after the lack of regulatory compliance was discovered. I also want to emphasize that the authority's general assessment is that Swedish pharmacies are not used for criminal activity. Since the deregulation of the pharmacy market in 2009, about a dozen pharmacy licenses have been revoked by the Medical Products Agency. This should be put into relation to the fact that there are currently approximately 1,400 physical outpatient pharmacies.
The case in question concerns special food products, where the pharmacies themselves can determine the price for these products. This is also a contributing reason why a majority of regions have chosen a solution where they themselves handle the procurement and distribution of these products without the involvement of the pharmacies. The investigation on the subsidization of special food for children (S 2022:09) proposes in its report Special Food for Children in Outpatient Health Care (SOU 2023:71) that this arrangement should be regulated by law. The proposal is currently being prepared within the Government Offices.
The Treklöver investigation (S 2021:09) has proposed that the regulation which means that doctors who prescribe medicines may not own pharmacies should also cover corporate groups in order to thereby cover the whole.
The Treklöver investigation has also submitted proposals regarding the duty to share information between the authorities that conduct supervision in the pharmacy area. According to the proposal, Läkemedelsverket, Tandvårds- och läkemedelsförmånsverket, and Inspektionen för vård och omsorg shall be able to share information that each authority needs for its supervision. Furthermore, the investigation proposes that Läkemedelsverket and Tandvårds- och läkemedelsförmånsverket shall be given improved opportunities to impose sanction fees, which will act as a deterrent for those pharmacy owners who consider committing regulatory violations.
The Treklöver investigation's proposals are being prepared within the Government Offices.
In conclusion, I want to state that the government takes the issue of welfare crime most seriously. A number of agency assignments have been given with the aim of countering this type of crime.
Eva Lindh (S)
Mr. Speaker! Yes, Svenska Dagbladet recently reported on how pharmacies have cheated themselves into millions without it being stopped. Pharmacies have incorrectly requested reimbursement for medication costs for patients who do not exist, or at least have not been customers or patients there, and got away with it.
Often, this actually concerns a crime scheme involving health centers and pharmacies in cooperation. It is outrageously upsetting. It affects society, because it steals important resources from healthcare - tax money that should go to our common welfare. It affects individual patients, whose resources are cheated away. It affects the trust for pharmacies and health centers.
The regions manage the payments for medicines to the pharmacies. They have limited insight. They cannot see what is prescribed or if it is reasonable. The regions that have the responsibility to manage an underfunded healthcare system must also take responsibility for this. They need help with both.
The National Audit Office conducted a review in 2022 of the state's supervision of pharmacies. It found that fraud in the prescription of certain medicines costs society large amounts in incorrectly paid medicine subsidies. It also found that neither the state supervisory authorities nor the regions have sufficient opportunities to access the fraud.
This report was issued in May 2022. What has happened since then is that the supervisory authorities have strengthened themselves, but it is not the case that we have changed any rules or anything else.
The Treklöver investigation that the Minister refers to points out a number of needs, for example, to access and limit the fact that corporate groups can be owned by those who own pharmacies. It also shows that there is a need for the possibility to split tasks, because if one cannot split tasks, it becomes very difficult to detect here.
The Minister responds that it is very few pharmacies that engage in this, and it is clearly true. It is not the case that pharmacies generally engage in cheating. But every instance of cheating is something that we must take very seriously. And since we do not have sufficiently good insight or opportunities to detect it, there may actually be more that we have not seen, so the cheating may be greater than we see and know about today.
We Social Democrats believe that welfare crime really must be curbed, for several reasons. It takes resources away from healthcare but also the important trust that we have been good at in our country. People have been able to trust the authorities and healthcare and have had confidence that things are done correctly and properly and, above all, that it is not possible to cheat money away from healthcare.
My question to the Minister is whether she shares my view that this is something outrageous that must not occur. Does the Minister also share the view that the government has so far not done what the Treklöverutredningen pointed out and what needs to be done?
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! I want to start with what the member wrote in his interpellation and which I believe we are in complete agreement on - that this is an issue that is partly passé because supervision and licensing have changed since then when it comes to special foodstuffs. Furthermore, we have a good basis for investigation that we are now working with in order to be able to move forward.
When it comes to welfare crime in general, it is a broad palette of measures that the government has taken. I was in the Committee on Welfare last December and accounted for them, Mr. Speaker, and I take the liberty of going through some of them here.
As the member mentioned, we have increased the funds to Ivo so that supervision can be increased. But we do many more things.
In June, we made a decision to produce a catalog of healthcare providers in Sweden. It is completely missing. It has never existed in Sweden. That means the authorities cannot even coordinate the information that comes up. We do not know who are the healthcare and care providers in Sweden.
We gave that assignment in June. That work is ongoing at full speed from the Public Health Agency. An interim report arrived a while ago which I would gladly recommend for reading. It shows the need to be able to coordinate tasks between agencies. Being able to coordinate tasks will become an important part of producing the national catalogue.
When we get there, we also realize that it will be difficult legally to ensure that we can share information between authorities. But the government assesses that it is necessary to proceed in those parts.
We have already received an investigation with proposals that are expected to be able to enter into force on 1 January. That report is currently being prepared. It concerns being able to improve opportunities to transfer information between law enforcement agencies.
We have also appointed a special investigator who will look into improved opportunities to do so in a specific order. We hope to receive a report on this already in August and then a final result.
We have submitted several assignments to supervision-related investigations which are also important. It concerns the entire field. It is not just about healthcare, but we unfortunately work with the entire welfare field.
We have given a mandate to the National Board of Health and Welfare to map and analyze the work of municipalities and regions so that what the authorities, respectively municipalities and regions do, does not overlap with one another.
We have previously given an assignment to the National Board of Health and Welfare to map the prescription of medicines that is not carried out within the framework of a healthcare provider. That partial report arrived last week or will arrive this week. I am a bit unsure, but I have received the report.
It is one of the things where we need to know much more. So far, we have more anecdotal information about how it can happen, which we all have. But we need to know for real. We have now received the underlying material from the authority, and we will proceed with that work.
We have also given a mandate to the Crime Prevention Council to look at what can be done to influence what is called insider. They are involved and influencing in all these parts. We can see this, not least in health and medical care.
We have examples of where someone delivering pharmaceuticals or medical technology products drives a pallet right in front of a garage door. But then they go home from work. They know where the pallet is. During the night, they come and take what is there. It is Tramadol, which they use very often to be able to commit the horrific crimes they commit within the gangs.
There are insiders in many different places. They may think they are a very small part and perhaps do not even think that they are committing a crime. But they are doing it, and they are complicit in all of this.
We also continue, of course, the work with the Swedish Payments Authority. We appointed a new investigation last week concerning when one uses their identification as a tool for crime and, with its support, commits a criminal act.
It is a large number of measures that we are now taking to tackle welfare crime. It takes money from the resources that we need in healthcare, but it also destroys the trust in society that someone can exploit the system in that way. That healthcare is used to commit crimes is so upsetting. Therefore, we must take all these measures at once.
Eva Lindh (S)
Mr. Speaker! When we meet the Swedish Economic Crime Authority, and I believe the Minister has also certainly done so, they say that healthcare has become a cash cow for criminal organizations. They also say that more needs to be done.
It is very good that the supervision has been strengthened. I also think that is good. But it is about being able to provide information. I want to ask the Minister about the change the Minister mentions regarding crime-preventing organizations being able to provide information to one another to curb crime. Will it really also apply to this type of welfare crime? It is good to know. It is a bit unclear.
It is needed. Being able to share tasks and information with one another is crucial in order to get a grip on the crime and criminality that lies far ahead. They do not have secrecy between one another. They utilize information between one another, just as the Minister also mentioned. What we need, to at least get a grip, is to be able to share information with one another in order to be able to detect and curb crime.
The second point concerns the investigation commissioned by the S-led government, the Treklöver investigation. It pointed out something that is also my assessment. What is needed is supervision and the ability to share information. But it is also about preventing certain crime schemes from being possible. It is about stopping the possibility of using our common welfare as a cash box to make criminal profits.
It could, for example, be that corporate groups cannot be allowed to own, just as the Minister was touching upon. It is also a message we can receive here today that it will no longer be possible. Is it something that the government will proceed with?
Every time one reads about welfare crime, one becomes very upset, not just as a politician but also as a citizen. The welfare that we truly care for and are proud of in Sweden needs all possible resources.
We would gladly have more resources, as has been discussed previously here. It is, of course, about resources from the government. The resources to the regions are insufficient to manage the healthcare crisis that exists. But the resources intended for and that should go to the welfare must also go there and not be available to make criminal profits from.
The government has now been in power for 14 months. There is a lot of talk about welfare crime. My view is that it is only about hunting the individuals. But it is companies, criminal organizations that form companies and are inside companies, that make the large criminal profits. We must put a stop to that.
All the efforts that need to be made must be made now to save welfare, but also to save the trust in our common welfare.
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! I truly agree that trust is the risk factor. I must be able to trust that when I contribute my common tax money, it goes to what is intended.
It is a matter of catching those who enter the healthcare system not to work in healthcare, but to steal money from it. Already today, municipalities and regions have the opportunity to review every single agreement they enter into. But it is quite obvious that they are not succeeding in finding them.
It is partly because they have not won the right to it. They have not gone through what kind of people are behind it. But it is also partly because they have not been able to access all the classified information and that they have not been able to share information. Even if an authority has found something that is problematic with a contractor, it has not been able to share it with anyone else. That is the work that we are doing right now.
I could stand here and say that it is a number of governments that have failed, because that is truly the case. We know that as early as 2010 somewhere, everyone noticed the problems within the assistance. Governments have come and gone. We have still not handled that issue in a sufficiently good way.
It continued when many people arrived here as unaccompanied minors and needed to be placed in an HVB home, a home for care and housing. Many were opened that were not intended to provide young people with help and housing but to make money and sometimes as criminal activity.
It has continued in area after area. Now it is healthcare that is next in line. One can see that very many governments have passed. There is very much that should have been done, but it has not been done.
That is why there are many investigations underway. It will take some time before all of these have landed, but it is necessary to go through all these areas. If one cannot get to share information, municipalities and regions will not be able to perform the full checks that they need to perform on those they enter into agreements with.
It is very clear in most legislations. If one sees someone who is involved in the context and who has a criminal background and is convicted of something, it is grounds for exclusion. But if one does not receive part of the information, how is one then supposed to be able to exclude and handle it?
There are many such examples that we encounter today when we listen to municipalities and regions. We ask: Why has nothing happened? Why is there not a single judgment where the laws have been tested? We do not have that.
The times we have caught the culprits is through tax legislation or something else. It shows that existing legislation with all supporting functions with secrecy-breaking provisions is not sufficient.
That is where we are working now. The laws that exist shall be supplemented with more information possibilities and more confidentiality-breaking provisions so that we can fulfill the mission. There is not a single municipality or region that is satisfied with the situation.
Right now we see that several regions are expanding their activities. Region Stockholm has done so for a long time. Västra Götaland is not far behind. But since then, there has been almost no one else who has noticed the problem.
Now they have started doing it in Skåne, and Halland has joined. Östergötland, Uppsala and many others are underway. It is really starting to come, and I am happy about that. But they cannot do this themselves, instead we must make the necessary legislative changes.
Ivo already came in 2019 with 40 different proposals where they felt that sharper tools were needed. The previous government implemented one and a half of them. We continue now, but many remain. Many governments have failed to do things. I am glad that the work is underway, but we must maintain the pressure. I am also glad that the Riksdag is active in the issue, which means that when the proposals land on the Riksdag's table, we will find a broad consensus in sharpening laws in many different areas. We need that.
Eva Lindh (S)
Mr. Speaker! I begin with Region Stockholm. They have noted that it is difficult to stop companies that have cheated. Even the Crime Prevention Council says that it is difficult to stop companies that cheat, for example by them using credible figureheads or straw men. We must do something about the system itself, that is to say, to detect, exercise supervision and obtain information that leads to inaccuracies and cheating being discovered. All of this is important.
But what I am asking for and really want an answer to is whether the government will do something about the companies that actually exist. Not all companies are bad, but those companies that should not exist in this market must be stopped. But many experience that it is not happening. Will the government do something about this?
There is a major pursuit of profit, which I believe should be stopped within health and medical care and within the entire welfare system. Money is disappearing, and it is money that should go to the welfare but instead goes to profits and profit withdrawals. Furthermore, money is being cheated away. These are large resources that could have been used for our common welfare.
My question remains: Will the government drive and do something to stop the criminally organized companies that cheat?
Statsrådet Acko Ankarberg Johansson (KD)
Mr. Speaker! I mentioned that this is already included in the legislation, that is to say, if a principal has a criminal background, it is possible to exclude them. It is already included in, for example, the law on choice systems.
But there are missing confidentiality-breaking provisions to be able to access everything. Some things have already improved in the municipalities, not least areas such as cleaning and construction. A lot has happened there. But one has not had its eyes on health and social care, and one must.
My answers have been about companies specifically. It is rarely about individuals, but rather a question of companies. But it bothers me that this has not been tested even once in any municipality or region based on the agreements that already exist, but instead it has occurred via the tax legislation. I want—and it is stated in the legislation—that agreements shall be followed up. The public shall have access to all necessary information, and the Local Government Act is far-reaching in that regard. They are not being fully followed up today.
I would like the existing legislation to be tested. The Government will continue with all measures that exist, including, among other things, tightened legislation. They affect almost exclusively companies, but also a few individuals. While the regions need to use the legislation that exists, we are working on strengthening and improving the legislation so that they receive more tools. Use what already exists so that we can find out where the limit lies! Today we know nothing because nothing has been tested.
Many laws are clear, and they do not exist without reason, but I believe that certain provisions that exist in LOU must be transferred to LOV. Furthermore, every region and municipality must first conduct an assessment before they enter into agreements; should they enter into agreements and on what terms? That mandate is fully given to municipalities and regions, and we hope that they use the mandate. Every tax krona shall go to welfare, and that is a priority for the government.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.