'Ghost consultations': Brussels medical centres accused of defrauding health insurance system

At least two medical centres in Brussels are using patients’ personal data to charge insurance providers for services that never took place, according to an investigation by Dutch-language news outlet Bruzz.

In one example, a Brussels resident discovered that his health insurer Christian Mutual (CM) reimbursed 21 consultations and home visits for six doctors in Anderlecht in the span of a year, totalling €265. But the resident had never seen those doctors, does not live in Anderlecht and was not even in the country for at least one of the alleged appointments.

Situations like this do not appear to be uncommon, Bruzz discovered.

In the case of this particular example, the resident had visited an Anderlecht centre once for blood tests, which allowed the centre to obtain his personal data.

Because doctors can enter a service into the reimbursement system up to two years after the date on which it took place, the Anderlecht doctors were even able to fabricate visits for dates before the man ever visited the practice. It appears the doctors created 33 total "ghost appointments" for a total reimbursement of €424.

After he discovered the appointments while reviewing his CM account online, the man filed a complaint with the CM, the National Institute for Sickness and Disability Insurance (Inami) and the Order of Doctors, which directed him to investigate the incident himself. Local police in turn said that it was not their jurisdiction.

“Entering benefits is very easy,” explained a general practitioner referred to only as "Lisa", who helped analyse reimbursements as part of the Bruzz investigation.

“Once your ID card is in our system, I can even pretend I've seen you every day and charge for that many benefits.”

No signature from the patient is required, with the purpose of this and other measures that make it easier to submit reimbursement claims intended to help make healthcare more accessible.

The doctors who were found to have charged false services in the case example are still operating at other medical centres in Jette, Anderlecht and Molenbeek.

Another man who visited the Maison Médicale Family in Molenbeek also discovered ghost appointments billed to his insurer. In both cases, the practices were not ones that the patients would have normally frequented. Rather, they ended up there through extenuating circumstances, such as a backlog at their usual provider.

Some of the centres suspected of committing fraud are even criticised for the practice in public Google reviews, with one that reads: "Ask for invoices from your mutual insurance company and you will be surprised."

Another constant in reviews of these centres is a noted lack of professional service, as if they did not want customers.

The doctors in question are almost all foreign, Bruzz found, mostly of Central African origin. Where they received their training is not clear, but they are recognised by the National Institute for Sickness and Disability Insurance (Inami).

The vast majority are not general practitioners, but doctors who have not (yet) completed the additional three-year training. They receive only €12.85 back from the mutual health insurance scheme, rather than the €25 a GP receives for a consultation.

That a group of doctors commutes between four health centres is itself remarkable, but the centres have something else in common - the same manager, who also appears to run a taxi company and used to run a company which traded in cars, real estate and white goods.

Other red flags about Maison Médicale Family is that their websites feature stock photos - which also appear on the websites of a Turkish clinic, a dental chair company and a marble floor maintenance company, meaning they are not photos of their actual premises - and little to no information can be found about the doctors working there. No names are even mentioned.

When Bruzz managed to get in contact with one of the doctors billing ghost appointments, they denied any knowledge.

“I only deal with consultations,” the doctor told Bruzz. “The secretariat enters the services based on the schedule, and takes care of the rest. The money from the mutual health organisations is paid into the medical centre's account. I myself am paid by the hour. As doctors, we do not carry out checks on what is charged.”

The manager of the affected medical centres ignored calls and requests for comments, but staff at his Molenbeek centre eventually replied via email to say that “it was a mistake.”

“It is an isolated case of three consultations wrongly charged to one patient, the money for which has already been refunded to the mutual insurance company,” the email claimed, and CM confirmed that payments had been reclaimed.

“There are certain things in the medical centre that escape the control of the management. We think the mistakes were made during the training of trainees and secretarial staff. Patients were used as examples, to show how the software works. Those consultations must have been validated rather than cancelled.”

"Lisa", the GP who helped Bruzz's investigation, added: "I think a secretariat can hardly commit fraud without the doctor's knowledge,” noting that booking the services is done through the doctor's account, and that doctor has to provide detailed info for invoicing.

Such kinds of health insurance scams are not unique in Belgium.

In April, it was found that a dentist from Maasmechelen fraudulently collected €200,000 by billing for dentures he never fitted. As in the case of the Brussels examples, the alleged patients had no idea the dentist was claiming to have provided services to them.

It was only because Christian Mutual recently started showing patients via ‘My CM’ what is reimbursed to healthcare providers that people began to notice fake appointments.

“Since I reported it, it did stop,” the Brussels patient said. “But what if I hadn't seen and reported anything?”

GP Lisa is also convinced that services are wrongly billed more often than many realise.

“As a doctor, you can now add all kinds of services, for example a cardiogram for an extra €17, or a telephone consultation for €11,” she said.

“But when is a phone call a telephone consultation? Doctors can abuse this very easily. There are many more options than, say, 10 years ago. The system is just asking for abuse.”

In Belgium, the payment to the healthcare provider is made by the mutual health organisations, but the money comes from the National Institute for Sickness and Disability Insurance, which is fed by contributions from employers, employees and the government.

The institute would neither confirm nor deny the suspected fraud that Bruzz uncovered, saying that “we never go into specific cases and cannot say whether an investigation is ongoing”.

But a spokeswoman did note that the organisation regularly received reports of abuse of third-party payment schemes and always analysed them.

The Medical Evaluation and Control Service (DGEC) conducted 871 investigations in 2023. Of these, 65 were determined to be fraud, defined as malicious, deliberate deception with the intention of enriching oneself (rather than negligence or mistakes).

Of those 65 cases, 30 concerned unperformed (but billed) services, amounting to €5.06 million. Twelve of those investigations involved a doctor, accounting for €2.26 million.

Fraudsters who are caught must initially repay the amount wrongly collected, plus any administrative fine. If there are serious indications of fraud, Inami can suspend the third-party payer scheme for 12 months.

The doctor will continue to work, however, as it is the Order of Doctors that decides on further sanctions.

“If the facts are established, a disciplinary sanction can be imposed: a warning, censure, reprimand, suspension of the right to practise medicine or expulsion,” the Order said.