Belgian Home Nurses Seek Mandatory Co-Payment to Curb Fraud

Belgium’s professional association for self-employed home nurses is calling for mandatory co-payments (“remgeld”) in home nursing to combat widespread fraud, following revelations that three nurses exceeded the annual billing ceiling of €235,000 in just the first four months of 2026. The Flemish Professional Association for Self-Employed Nurses (VBZV) argues that requiring patients to pay a small fee per visit would create an essential additional layer of oversight.

The Scale of the Problem

Health insurance funds conducted their first proactive checks using a newly introduced annual billing ceiling and discovered alarming results. Three self-employed home nurses had already surpassed the €235,000 ceiling by April 2026, with the most extreme case involving billing of €281,500, according to VRT NWS. Each of the three nurses billed more than €58,000 per month to health insurance funds.

Paul Callewaert of Solidaris, speaking on behalf of all Belgian health insurance funds, described the figures as staggering. “Yet that ceiling is quite generous. Billing €235,000 per year amounts to about €19,000 per month. Even someone working six days a week, 15 hours a day, would at most reach €12,000,” Callewaert told VRT NWS. “The three billed €58,000 per month. That’s insane and almost unbelievable.”

Beyond these three extreme cases, 94 other nurses received warnings, and 400 are being closely monitored due to rapidly rising billing figures.

The VBZV’s Proposal

Sandrina Peeters, General Director of the VBZV, is calling for mandatory co-payments as an additional control mechanism. Currently, co-payments in home nursing are optional and not systematically applied. “When patients receive an invoice, they immediately see which services are being charged. This way they can help check whether everything is correct,” Peeters said.

The VBZV argues that the upcoming mandatory electronic identity verification—scheduled for January 2027—is insufficient on its own. Peeters noted that even proper eID reading did not prevent a major fraud case uncovered in November 2025, when a home nurse in Houthulst, West Flanders, was suspected of multimillion-euro fraud, with investigators seizing 17 luxury vehicles, real estate, and cash.

Patient Protections and Concerns

Under the proposal, patients would be protected by the maximum billing ceiling (maximumfactuur or MAF), which ensures that once a patient reaches a certain out-of-pocket threshold, their health insurance fund reimburses the co-payment automatically. Nearly half of patients receiving care from Wit-Gele Kruis, one of Flanders’ largest home nursing organizations, qualify for increased reimbursement status, meaning minimal co-payment.

Since September 2025, Wit-Gele Kruis branches in Limburg, East Flanders, and Flemish Brabant have already begun collecting co-payments, as detailed on their website. The amount depends on the patient’s social status, care dependency, frequency of care, and type of care.

Broader Regulatory Context

The proposal comes amid a wider government crackdown on healthcare fraud. Following the Houthulst case, Health Minister Frank Vandenbroucke announced several measures, including a daily limit on billable visits, authority to temporarily suspend provider licenses, and mandatory eID card reading at every visit from 2027. Health insurers are now required to detect €25 million in fraudulent activity in 2026, rising to €100 million by 2029, or face funding cuts.

Analysis and Implications

The VBZV’s proposal highlights a fundamental tension in Belgium’s healthcare system: balancing fraud prevention with accessibility of care. Critics argue that mandatory co-payments could create a financial barrier for vulnerable patients, particularly the elderly and those requiring frequent care. However, supporters point to the MAF system and increased reimbursement status as safeguards.

The case also reveals systemic vulnerabilities in Belgium’s healthcare billing system. Callewaert noted a recurring pattern: “High billing figures often go hand in hand with not reading the electronic identity card of patients.” The new eID requirement closing one loophole, but as Peeters argues, even that measure proved insufficient in the Houthulst case.

What’s Next

The VBZV’s proposal now enters the political arena, where it will likely spark debate among patient advocates, health insurers, and policymakers. With mandatory eID verification set for January 2027 and insurers facing escalating fraud detection targets, the pressure is mounting for effective solutions. The question remains whether mandatory co-payments will become part of Belgium’s multi-pronged strategy—or whether alternative measures will prove sufficient to root out fraudsters who, as Peeters put it, are “a stain on the entire profession.”