The Swedish Health and Social Care Inspectorate (Ivo) launched a nationwide investigation into unscrupulous and criminal actors within the healthcare and social care sectors in 2024. Initial investigations, focusing on over 80 companies and operations in social care, including residential care homes for children and young people (HVB), supported living facilities, and home care services, along with roughly 40 healthcare providers such as primary care, dental care, and aesthetic clinics, revealed a deeply concerning situation. Ivo’s intensified oversight resulted in the closure of 58 facilities: 47 within social care and 11 within healthcare, and over 130 professional practitioners faced police or prosecution reports. These closures included 18 HVB homes, highlighting the vulnerability of children within the system. This new focus on criminal activity represents a shift for Ivo, requiring new working methods to address the sophisticated business models employed by these actors.
Ivo’s traditional focus has been on quality and patient safety. However, this new mandate necessitates an evolution in their approach. The criminals they are now encountering operate with more complex and systematic strategies, creating intricate corporate structures designed to obfuscate their activities and evade scrutiny. Peder Carlsson, a department head at Ivo, notes the shift from previous cases of economic crime, such as falsified invoices for unrendered treatments, to these more sophisticated schemes. These actors exploit loopholes and gaps in inter-agency oversight, operating in spaces previously beyond Ivo’s regulatory reach. The primary motive for these actors is profit, not the provision of quality care, resulting in substantial financial gains, even within short operational periods.
The urgency of the situation is underscored by the government’s additional directives to Ivo. Following a February 2024 mandate to address unscrupulous actors and welfare criminality escalating within care and LSS (Act concerning Support and Service for Persons with Certain Functional Impairments), a further directive arrived in August, prompted by a newspaper report detailing criminal operations within HVB homes. This directive reinforced the need for strengthened supervision of supported living facilities and HVB homes. The prevalence of these criminal enterprises exposes systemic weaknesses within the care sector, demonstrating how easily these organizations can infiltrate and exploit vulnerable populations.
A key aspect of Ivo’s ongoing work is developing more effective methods for scrutinizing these unscrupulous actors. Anna Karin Nyqvist, a unit manager at Ivo, emphasizes the need for continuous methodological development to identify and effectively investigate these actors. Inspections revealed a disregard for mandatory background checks, the employment of unsuitable personnel with serious criminal records caring for children, and deliberate obstruction and evasion of Ivo’s inspections and licensing processes by these criminal enterprises. Tactics include providing false information and using front companies to conceal unsuitable representatives who fail to meet legal requirements. Such deceptive practices highlight the deliberate and calculated nature of these operations and the lengths to which these actors will go to maintain their illegal activities.
The severity of the situation is further underscored by the frequent need for police presence during Ivo’s inspections. Nyqvist highlights the necessity of police involvement in situations involving suspected criminal activity, potential obstruction of access to information, or threats to Ivo personnel. This extends to primary care facilities as well, indicating the widespread nature of the problem. The high rate of rejected license applications further illustrates the pervasiveness of unqualified and potentially dangerous actors seeking to operate within the care sector. In the past year, Ivo rejected approximately 30% of all license applications, primarily within home care and HVB, and a striking 50% of applications for HVB homes.
Ivo has strengthened collaborations with the police, the Swedish Tax Agency, and the Swedish Economic Crime Authority, but sees the need for more efficient collaboration with municipalities, urging them to intensify their efforts. Internally, Ivo is undergoing a continued transition to adapt to this new landscape of criminal activity. This includes developing strategies to better identify and investigate these actors. Furthermore, Ivo has proposed to the government that healthcare facilities also be subject to licensing requirements. Currently, no licensing is required to operate a primary care center, hindering Ivo’s ability to revoke permits and necessitating a focus on quality assessments, a process that can be circumvented by criminal organizations. This lack of regulatory oversight leaves a significant gap in the system, allowing potentially harmful actors to operate unchecked. The need for systemic changes, including enhanced inter-agency cooperation and stricter licensing requirements, is crucial to protecting vulnerable individuals from exploitation and ensuring the integrity of the care system.
