Response to interpellation 2024/25:693 on criminal and unserious actors within healthcare
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
1 KD considers it unacceptable that criminal actors exploit the welfare system and that crime against healthcare and elderly care must be taken most seriously 1. 1 2 KD argues that the government has decided on measures to provide Ivo with resources and tools to audit company structures 1 2. 2 KD argues that the regions themselves manage their contracts and that work is being done to find the right requirements to stop criminals 2. 3 KD denies that they are turning a blind eye and asserts that they are doing everything they can from a national level 3. 3 KD considers it the regions' responsibility to conclude contracts with private actors since the state does not have any healthcare of its own 3. 3 KD welcomes state decisions on contracts to stop criminals and reduce unnecessary administration 3. 3 KD argues that they should not stop using private providers as residents should have the opportunity for a private health center 3. 3 KD emphasizes the need for reasonable controls and that state, region, and municipality must cooperate to stop crime 3. 4 V argues that it costs a lot to follow up on private actors and that the freedom of establishment must be reviewed 4. 4 V considers that tax money must be prioritized for healthcare and the patients 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)
Madam Speaker! Karin Rågsjö has asked me what further initiatives I intend to take to stop criminal actors within the welfare sector.
As Karin Rågsjö notes, we agree that it is completely unacceptable that criminal actors exploit Sweden's welfare to finance criminal activities. Naturally, I also fully agree with the view that we are in a serious situation and that crime against healthcare and elderly care must be taken most seriously.
Against that background alone, I have, together with the government, decided on several interventions in the work against welfare crime within healthcare and elderly care. I accounted for several of those measures in my response to the written question 2024/25:1143 Criminal actors within healthcare.
In addition to the measures I have already accounted for, the Ministry of Health and Social Affairs has referred the memorandum Improved conditions for IVO – proposals to counter unserious and criminal actors within healthcare. The memorandum proposes, among other things, a possibility for Ivo to issue a sanction fee or prohibit an activity that provides healthcare but has not fulfilled its reporting obligation according to the Patient Safety Act (2010:659). The consultation period expires on September 29 this year.
On May 28 this year, the government also tasked several authorities to jointly consolidate efforts against organized crime and the criminal economy in the welfare sector (S2025/01085). Based on the Swedish Police Authority's situational picture of active gang criminals in Sweden and other relevant authority information, the concerned authorities shall, among other things, check their administrative decisions and payments where these individuals appear. And measures shall be taken to prevent individuals, representatives, and private actors from organized crime from re-entering the welfare systems on false grounds.
The work against unserious and criminal actors must become both faster and more effective. Therefore, the government is now consolidating forces in a unique way.
In conclusion, I want to highlight that the government is working broadly to counter and prevent unserious and criminal actors within the health and medical care sector. The government maintains a close dialogue with relevant authorities and other actors to identify the need for measures against welfare crime, both in terms of what the government can do and what other actors can do in their respective mandates or in cooperation with one another.
Organized crime and the criminal economy in the Swedish welfare state must be countered with the collective capacity of society.
Karin Rågsjö (V)
Madam Speaker! Thank you, Minister, for the answer!
When the mafia has wormed its way into the welfare system, for example healthcare, all alarm bells should be ringing. When I enter one of the countless vaccination centers that exist, I do not want Bandidos or any other mafia activity laundering money there. I do not designate this as welfare crime but want to designate it as mafia. A mafia has wormed its way into the body of society and gains access to power over our lives and our health.
The previous bourgeois government and the now SD-dependent government are giving the mafia the conditions to operate within the welfare sector. We believe that it is the free choice of care and the freedom of establishment that have opened the door for welfare crimes and thus the mafia. Money as incentives and profits in welfare create a quite sick culture.
Criminal actors conduct activities within the publicly funded welfare sector. They earn large sums by impoverishing our common welfare while simultaneously controlling sensitive operations that affect very many people.
Among the examples that have been highlighted is the suspected white-collar crime scandal in Västra Götaland, where it has been decided to terminate the contracts for three health centers. It is 11,000 people who are affected by this. Recently, Ekot also reported that Region Stockholm terminated contracts with a healthcare group that had links to Bandidos and the crime-suspected health centers in the Västra Götaland region.
We have also seen this within personal assistance and HVB, but now the alarms are coming from healthcare. Recently, the Economic Crime Authority alerted about how welfare is being used as a tool for crime. Just before the turn of the year, ETC reported on how companies conducting activities subject to licensing are bought and sold without control. The new owners do not meet the requirements for the activities.
At the same time, Ivo has repeatedly pointed out that they lack sufficient resources and tools to fulfill their mandate. The agency describes how their mandate has become much more complex, and that is understandable. It has gone from focusing on the quality of care and nursing to also auditing corporate structures, front organizations, the presence of drugs and weapons, and gang-related crime. Has Ivo become some kind of FBI? Something is very dysfunctional.
The Minister and the others within the Tidösamarbetet often talk about how much overadministration the regions engage in – the inefficient healthcare. With this policy, which gives the mafia the conditions to make money from welfare, the regions will need to build up units to stop the worst crime – large control units that take money from healthcare. Then one can think that we are really talking about overadministration.
Instead, we want to see a three-year moratorium on the establishment of new companies in the healthcare, school, and care sectors to clear out criminal activities. We want to abolish the systems that allow for profit-seeking within healthcare and ensure that limited companies as actors within healthcare are not permitted, and establish a new special unit at the Economic Crime Authority for the purpose of investigating private companies that conduct welfare activities in order to be able to detect, ban, and prosecute the gangs. We do not consider the measures that the government constantly comes up with – one ends up a bit in the wake because these are unfortunately very creative actors – to be sufficient to close the conditions for the mafia to act within Swedish welfare.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Thank you, the member, who once again raises the question!
It is absolutely correct that we have inherited problems. Much should have been done over a long period. That as the person responsible for health and medical care in the government, I would need to spend so much time stopping criminals, was not how I envisioned the assignment – I want to be very clear about that. It is about many years of inherited problems that nothing has been done about, so I completely agree with the member that much more should have been done. But we are doing a lot now.
Let me begin by saying that every time an activity is transferred from a region or municipality to someone else, one must, according to the Local Government Act, establish an agreement, and one must ensure the oversight that the public demands. One must therefore know what kind of company it is, how they perform their task, and that one has the possibility to follow up. It is not the case that the regions are in the hands of someone else. They have complete control over which agreements they sign. There, I believe we have a job to do together, with good tips on how one can do it.
I have read through the so-called rulebooks that the regions make decisions on – they should preferably make decisions on them in the municipal council annually. I note that one of the regions – I shall not mention which one here – has connections to the old Local Government Act. When one even has connections to an old law that ceased to apply in 2017, it is clear that one is not up to date in its rulebooks.
I believe there is much to do. I see both good examples from regions and some cases where one thing and another need to be corrected so that we have agreements that follow up on what is essential. The member is onto a very important point. Sometimes we fill the rulebooks – they are often quite thick – but still, they have not stopped the criminals. We have, therefore, focused on the wrong things when the regions have concluded agreements and written their rulebooks.
We should consider which requirements are expedient, probably fewer, not least so that those who are skilled and serious can start their own business without too much administration. But we must focus on what the criminals do so that we hit the mark there. We believe that we need to do that work together, and I will return with initiatives regarding that part.
However, we have ensured that all the things that Ivo needs are underway. They needed resources and more tools. Last year they received 30 million extra. Now they have 28 million annually in increased framework to tackle welfare crime. It is a significant amount of money that enables them to do exactly what the member is highlighting. It is not only about looking at quality and treatment, as one is used to, but also about being able to audit business models and company structures to find what is criminal.
They have also received many new tools, and more are on the way through all the government inquiries we have commissioned. We have that order in Sweden – and I am proud of it, Madam Speaker – that we do not just let some minister read something in the newspaper and then enact a law the same day. Instead, we commission inquiries to obtain a good basis. We refer them, and then we make decisions in this chamber on which laws we want. I hope that the many inquiries will soon also return to the Riksdag for a decision.
It is only one choice of care that is mandatory for the regions, and that is the choice of care for primary care. Almost half of Swedes today go to a private health center. That is the only thing that is mandatory. Otherwise, the regions decide for themselves which choices of care they make. It is up to each region how they want it and which agreements they sign.
But where there is to be a choice of care, that is to say when it concerns primary care, one needs to ensure that one has good agreements and that one follows the right things. I think that over the past year we have received so many examples from regions that have tried but not succeeded that we could help each other to get good agreements so that we can phase out actors who are directly criminal.
The member's point regarding Västra Götaland illustrates this: how we have worked intensively with these actors for several years and it has been difficult to get rid of them. Now, it has been achieved. But it required a police operation and Ivo before the agreement could be terminated. We therefore need to do more to be able to increase the sanctions and stop these actors.
Karin Rågsjö (V)
Madam Speaker! Thank you, Minister, for the answer!
Unfortunately, it turns out that both the region and the Riksdag and government are running after the mafia. They are faster than we are, unfortunately.
The Economic Crime Authority has for quite some time warned that the source of income is no longer primarily drugs but welfare crime. That, of course, makes me very worried. One can only look at the sea of vaccination centers that exist, and so on.
Do we know what is going on? Is it a matter of extortion or infiltration? We don't know at all. But we know that this will be, or is, system-threatening. We have a welfare construction with freedom of establishment, with minimal control – for the control is still minimal unless the regions build up incredibly large "investigation" parts. When profits are the incentive, I mean, this drives forward dysfunctional systems.
I think we are under attack. One sees criminals making profits from common tax funds by conducting activities within the welfare sector. Private companies controlled by criminals start and run, for example, health centers – we have seen that – and vaccination clinics. There is then a way to both take out profit from tax money and launder money from criminal activity.
This naturally means great losses for welfare and also a clear threat to those who are patients. In the long run, it is also a threat to the welfare system, the rule of law, and democracy in Sweden. There is a systemic error within healthcare regarding this.
The possibility for private actors to make money from tax-funded welfare also entails enormous costs for the public sector. Just the personnel costs to monitor the private companies operating within the welfare sector amount to around 25 billion kronor per year, according to a fairly large investigation from LO. Is it reasonable that the market zeal within the right and Centerpartiet is allowed to cost whatever it wants?
That profits in welfare create revolving doors for welfare plunderers is accepted by not reforming the systems. We have the law on freedom of choice and freedom of establishment in primary care across the entire country.
In Stockholm, where privatization has gone very far, the previous Moderate-led government introduced establishment freedom in about forty primary care areas. This covers everything from gynecology to eye care. In that case, it becomes incredibly important to monitor those operations. It is precisely the same freedom of choice legislation that also opened the door for extensive fraud and enabled unserious criminal actors within home care services, for example. What has happened in Stockholm is something everyone should try to learn from.
Vänsterpartiet has long pointed out the serious consequences of letting go of control over healthcare to private actors. I think that is what is being done. Politicians sit in the stands. It has not only led to the mafia having room to maneuver but also to an unequal distribution with over-establishment in cities and other resource-rich areas and large white spots in suburbs and in the countryside. When dictatorships such as China and the United Arab Emirates show interest in becoming owners of Swedish health centers – it has not happened yet, as far as I know – one becomes truly worried.
I still ask: Where are we headed? Sweden is unique with its system of a healthcare market and a system that creates conditions for profits in welfare. I still mean that you are turning a blind eye to this.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! No, we really do not turn a blind eye. We do everything we can from the national level.
I know the member dislikes that I speak about it being the regions' responsibility, but that is what it is. It is the regions that enter into agreements with private actors. We have no state healthcare. We have no possibility to influence what the agreements look like. If the member wants us to have it from the state side, I welcome that. I would not mind if we also decided at the state level what an agreement should look like, both to ensure that it does not become unnecessary administration and to stop those who are criminal. I would welcome such an initiative from Vänsterpartiet.
It is necessary that those who do manage to some extent can share good experiences, but there are too many who do not care. I share the member's view that there are too many politicians who do not care about these agreements.
Everything one delegates to someone else must be agreed upon by contract according to law, and if one does not care about what the agreements look like, or fails to follow up on them, one can easily end up where one has now ended up.
Let me nevertheless say that Stockholm has worked for a long time with this issue. The previous government started the work and has pursued it vigorously. Västra Götaland has also carried out such work. But even in Västra Götaland, where this has been pursued for a long time, one is hit by problems, which, just as the member says, shows that these criminals are extremely skilled.
We must ensure that we are ahead. There I share the member's view: We are not ahead, but behind. All the time we discover new schemes that we stop. Then we discover another new scheme and stop it. We are not, as it were, ahead of the criminals, because they are resourceful and choose systems.
What can be done then? The member's view is that we should stop using private providers. I do not think we should do that. Half of all residents have access to a private health center, and I think they should continue to have that. That is the only thing that is legally mandated. Otherwise, it is up to each region to decide which areas they want to have as choice of care and what requirements should apply.
When one has to do something quickly, one can let problems in. We saw it during 2015, when we needed many homes for care and housing for children who came alone to Sweden. It opened up for a criminality that we still live with. During the pandemic, we needed both control – do I have covid or not? – and gradually also vaccination. It was to happen quickly. Seen in the rearview mirror, there were many who did not even do the tests they were supposed to, and it was not patient-safe. Furthermore, money disappeared to others.
This shows that when a lot needs to be done quickly, we need to become even better at ensuring that it happens in a patient-safe manner and that we do not let criminals in. The other thing is the long-term, and we are doing that right now through the investigations we have commissioned and the additions we have made to be able to stop criminals.
I share the member's view: Here, state, region, and municipality must act together and push forward. If we make things more difficult for different parts, perhaps we can push back a part of the crime. Preferably, we want to get everything out, but we know that a large part of the money that goes to criminals comes via payments in the social insurance system. Work is ongoing on the government's side. Work is ongoing within social services and within HVB and other types of housing to stop this, as well as within health and medical care.
Unserious actors can be criminals. They might not have links to the mafia but still be unserious by exploiting the system. We therefore need to keep our guard up. I think it is important to have a trust-based operation in some sense. We should not believe that everyone who wants to participate is a criminal, but at the same time, we must assume that there could be someone who is. In that case, we must ensure that we have reasonable controls.
Karin Rågsjö (V)
Madam Speaker! It costs 25 billion per year to monitor all private actors within the welfare sector. Is that not an extreme sum that could be used a bit more efficiently?
For the regions, which must build up their investigative activities in order to be able to check the companies that enter, it will cost a huge amount of money. Will the state then step in with more funds, or will it be money that is to go to healthcare that should be used in that way?
It is obvious that the mafia now sits in various activities, also within healthcare. It naturally damages trust.
State support for the regions' work against welfare crime, as the government proposes, is of course welcome, but building up more central control functions to hunt welfare crime will not have an effect until the freedom of establishment is reviewed. We are absolutely not against the private sector, but it is more about how one rigs the whole thing – what one requires and so on.
It is clear that a completely different meeting regarding the problems from the state, regions, and municipalities is needed, just as the Minister says, to put a stop to it. In that case, one must do things together. But I still wonder what comes first: Is it that the private sector should expand within health and medical care and thus also the criminal activity, or is it that our tax money should go to the care and to the patients?
I believe, in fact, that it will cost an extreme amount of money to set up systems in regions, municipalities, and the state to get a grip on the criminals – on the mafia. In that work, one must find ways forward and perhaps also "kill one's darlings" in that work.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I believe we are in complete agreement that criminals should not be present in the welfare system. I do not recognize the figure of 25 billion for the entire welfare system, so I will have to read up on how much concerns healthcare.
I think like this: For all healthcare that is performed, we must know that it reaches the patients in the best way, regardless of who performs it. But even for that which is performed in-house, we must ensure that there is reasonable control and follow-up. What we have seen now is that administration and follow-up are swelling a great deal. That is one side.
The other side is that we see a need for increased control because there are criminals. Here, it is a matter of us managing the balance. We must ensure that we have purposeful administration, control, and follow-up, and that we find what actually stops the criminals. It is about billions that are disappearing out, and the government's view is that healthcare should be need-based – it should be governed by who has the greatest need, not by demand.
There are no goals regarding what proportion should be private. The only steering today is that one shall provide choice of care within primary care. Half of the Swedes have chosen to go to a private health center.
We intend to continue our work by doing everything we can to stop criminals in all areas concerning welfare. The member's demand for a three-year stop, she may well take up with the coalition she intends to join after the next election. But we intend to do what we can to stop criminals.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.