Care money must be traceable in your accounts from source to destination, and kept apart from your other activities. Article 40a of the Healthcare Market Regulation Act requires this. If the care company lends money to the director or to a related company, or pays the director, there must always be an agreement, invoice or payslip behind it.
A decision by the Dutch Healthcare Authority (NZa) of September 2026 shows how this goes wrong. The fine went to the company and, as the de facto manager, also to the director personally.
In short
- The NZa fined Balans Thuiszorg B.V. € 100,000 and the director € 30,000. Payments to the director and loans were not traceable, and care and other activities were financially mixed.
- Article 40a Wmg requires three things: a written division of financial tasks, financial separation of care and other activities, and every receipt and payment traceable to source and destination.
- The fine can reach € 500,000 or 10% of turnover. For tax purposes, debts to your own company above € 500,000 on 31 December are also taxed in box 2. The government wants to lower that limit from 2027. That is a proposal.
In this article
Why were a home care company and its director fined?
Because the NZa could not establish whether the care money was spent properly. Balans Thuiszorg B.V. provides district nursing to around 130 clients in Oosterhout and the surrounding area. Due to missing invoices and (loan) agreements, payments could not be traced, including payments to the director herself (NZa, 21 September 2026).
The NZa also found that care activities and other work were not separated in the accounts, and that it had not been recorded who had which financial tasks. According to the decision this applied to the period from 1 January 2023 to March 2025. The company was fined € 100,000, the director as de facto manager € 30,000 (NZa, Fine decision Balans Thuiszorg B.V. and director, case 552717).
Important for every owner: the offence was not that money disappeared, but that nobody could see where the money came from and where it went. The fact that the director later gave explanations did not help without documents to support them.
What does article 40a of the Wmg require?
Three things. The care provider divides the tasks, powers and responsibilities for financial management clearly and records them in writing. It distinguishes its care activities financially from its other activities. And in the accounts, receipts and payments are traceable to source and destination, and it is clear who entered into which obligation when (Healthcare Market Regulation Act, article 40a).
The rules apply to all care providers paid from the Zvw, the Wlz or a Ministry of Health subsidy. A self-employed person who provides all care personally without involving others falls outside them. Even if only one person does the financial tasks, according to the CIBG this must be clearly recorded (CIBG, Financial management and derivatives).
Separation does not require two companies. The CIBG mentions separate accounts, or one set of accounts in which each income and receipt shows whether it concerns care. Examples of other activities are a dentist who also sells oral care products, or a care farm with agriculture (CIBG, Financial management and derivatives).
What exactly did the NZa find in the accounts?
The decision describes specifically what went wrong (NZa, Fine decision case 552717):
- The director received a payment described as dividend 21 times in 2023 and 43 times in 2024, without a dividend resolution. Later it was said to be repayment of a debt owed by the company to the director, but that debt was not supported by any document.
- In addition, money was paid to the director 24 times in 2024, including salary. Eleven of those payments could not be traced, for example because a description was missing or consisted only of a code of letters and numbers.
- A coordinator received a management fee into his sole proprietorship, without a contract and without documents showing what work was done for it.
- There were loans to a related organisation of the same director. There was one loan agreement from 2021, but after that other amounts were also lent without anything being recorded. A current account agreement was missing.
- The company paid cleaning firms for domestic help, but did not separate that activity from care. Part of it was booked as maintenance of real estate, although the company owned no property.
How high can such a fine be?
For a breach of article 40a the NZa can impose a fine of at most € 500,000, or 10% of turnover in the Netherlands if that is higher (NZa, Fine decision case 552717, paragraph 196). The NZa classified these breaches as very serious in this case.
For very serious breaches the NZa starts at 2.5% of net turnover up to € 1 million and 1.25% of turnover above that up to € 20 million. Because the director was the sole shareholder and was also fined personally, the NZa reduced the company's fine by a third (NZa, Fine decision case 552717).
In addition, a breach of article 40a is an economic offence. According to the decision this can carry, among other things, detention of up to six months (NZa, Fine decision case 552717). The NZa also shares findings with health insurers and the CIBG, as it did in April 2026 with nine district nursing providers (NZa, 22 April 2026).
May you as owner-director borrow money from your care company?
The Wmg does not prohibit borrowing. But every loan must be traceable: who entered into which obligation when, and where did the money go (Wmg, article 40a(4)). In practice this means a written agreement with amount, interest and repayment, and a current account agreement if you regularly withdraw or repay money.
If your company falls under the profit ban, take extra care. When applying the profit ban the NZa also checks whether an institution has created the possibility to distribute profit (NZa, Policy rule TH/BR-033). A loan to the shareholder without arm's length terms can raise questions about that. Never take dividend without a written dividend resolution either, because that is exactly what was missing in the Balans Thuiszorg case (NZa, Fine decision case 552717).
For tax purposes there is a separate limit. If, together with your partner, you owe more than € 500,000 on 31 December to companies in which you have a substantial interest, the excess is taxed in box 2, as if it were a distribution. An owner-occupied home loan does not count if the company holds a mortgage right (Income Tax Act 2001, article 4.14a).
The government wants to lower that limit from 2027 in five steps of € 80,000 to € 100,000, excluding the owner-occupied home loan (Accountancy Vanmorgen, 29 September 2026). That is a proposal. If you currently have a substantial debt to your company, look now at how to repay it or convert it into salary or dividend (owner-director salary calculator).
How do you set up your accounts so that care money can be traced?
With a few fixed habits. The decision on Balans Thuiszorg shows which were missing:
- Record on one page who may make payments, who approves invoices and who keeps the accounts. Even if you do all of it yourself.
- Label every item of income as care or other, or keep separate accounts for non-care such as cleaning, sales or rental.
- Pay yourself through payroll or on an invoice backed by an agreement, never with loose transfers without a description.
- Put every loan and every current account on paper, with amount, interest and repayment, and book every withdrawal with a reference to that agreement.
- Conclude an agreement with every subcontractor and every hired firm, and keep the invoices.
Those who finance care are looking ever more closely. Research on Dutch care organisations after the system reform and the financial crisis showed that banks began to set higher requirements for loan applications, and that health insurers tightened their monitoring and accountability requirements (Van Dijk et al., 2023).
Separate money also helps your peace of mind. A study of entrepreneurs with a family business in South Korea found that mixing private and business money went together with more stress, through a poorer balance between work and family (Choi & Kessler, 2023). That is a different country and a different sector, but the lesson is the same: a clear separation gives calm and overview.
Sources
- NZa, Fine for home care organisation Balans Thuiszorg B.V. for deficient financial management, 21 September 2026 (in Dutch). nza.nl
- NZa, Fine decision Balans Thuiszorg B.V. and director, case 552717, signed 1 September 2026, published 21 September 2026 (in Dutch). puc.overheid.nl
- Healthcare Market Regulation Act, article 40a, version 1 September 2026, read via the BWB repository (in Dutch). wetten.overheid.nl
- CIBG, Financial management and derivatives (in Dutch), accessed 1 November 2026. toetredingzorgaanbieders.nl
- NZa, Policy rule TH/BR-033 Transparent business operations and ban on profit motive, valid from 1 January 2022 (in Dutch). puc.overheid.nl
- NZa, Order subject to a penalty for 9 district nursing providers, 22 April 2026 (in Dutch). nza.nl
- Income Tax Act 2001, article 4.14a, version 21 February 2026 (in Dutch). wetten.overheid.nl
- Accountancy Vanmorgen, Cabinet wants to lower the excessive borrowing limit to € 100,000 and the higher box 2 rate to 29.2 percent, 29 September 2026 (in Dutch). accountancyvanmorgen.nl
- Van Dijk, T., Van der Scheer, W.K., Felder, M.M. & Janssen, R.T.J.M. (2023). Health care reform and financial crisis in the Netherlands: consequences for the financial arena of health care organizations. Health Economics, Policy and Law, 18(3), 305-320. doi.org
- Choi, J. & Kessler, D. (2023). Influences of start-up's financial intermingling on entrepreneurial stress in sustainable family businesses: mediation effect of work-family balance. Sustainability, 15(18), 13944. doi.org