Healthcare purchasing, procurement and insurance law

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Healthcare purchasing concerns healthcare or welfare services within the social domain that are purchased by the care administration office, the health insurer or municipalities for the benefit of the insured person, client or consumer. These may involve large sums of money and interests. In the system of regulated market forces, healthcare purchasing consists of more than just the contract itself. It is a legal field in which a broad and specialised view is required. Sometimes purchasing involves a mandatory tendering procedure, sometimes procurement law is not or less relevant.

Knowing where you stand

It is very important that you, as a healthcare provider, know where you stand, for example because an incorrect submission of a tender may result in you no being awarded a contract to provide healthcare. Kienhuis Legal can advise and guide you in this (whether or not in the background) so that you take the right steps. We can also advise on drafting the specific contract documents.

Procurement law

For example, in practice we increasingly see disputes that concern the question of what the compensation should be that the healthcare provider receives for the care or service provided (the doctrine of fair rates). Ground rules of procurement law are also sometimes not properly followed by, for example, municipalities, resulting in certain providers being wrongly awarded a contract and others not. Where necessary, we conduct legal proceedings (in preliminary relief proceedings) to enforce or maintain fair rates or to ensure that a tender procedure must be adjusted or withdrawn.

Health insurance law

We also know everything there is to know about health insurance law. When do we speak of ‘insured care’? What are the entitlements under the Healthcare Insurance Act [Zorgverzekeringswet] and the Long-Term Care Act [Wet langdurige zorg]? What about the 'free choice of doctor'? We can also provide assistance in disputes concerning, for example, material controls and reimbursement of care. We advise you on relevant legislation and regulations in the field of health insurance law and healthcare purchasing. This includes interpreting laws and guidelines, identifying compliance risks, and developing policies to comply with regulations.

What we do

Kienhuis Legal has extensive experience in assisting healthcare providers, municipalities and care administration offices/health insurers with all aspects of healthcare purchasing. We advise and guide you in the background and, where necessary, we take the lead in conducting summary proceedings. For example, to enforce certain rates or to put a tender procedure on hold.

We also guide our clients if the concluded contract gives rise to practical and legal questions, for example about the amount of the reimbursement, questions about the termination of the contract and the legitimacy of the declarations submitted by the healthcare provider (material audits).