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The NHS Counter Fraud Authority (NHSCFA) is launching an investigation into GPs in England who they suspect are claiming for “ghost patients”. The investigation has come about because there are 3.6 million more patients on the system than there were people in England.
GPs receive £150 a year for each patient on their list.
A full analysis of records held by NHS England and the NHS Business Services Authority, which administer the payments systems to GP practices, will be conducted to see if doctors have been fraudulently claiming for patients.
The NHSCFA has the power to investigate suspicions of fraud, not only of health professionals working within the NHS, but management and administrative staff, and dentists and opticians who have NHS contracts.
It is estimated that fraud costs the NHS £1.3 billion per year, a shocking sum, given that every penny is needed to provide care and support to patients. However, all investigative authorities are fallible, and the NHSCFA is not immune to making mistakes.
A 2014 research paper published in the British Medical Journal showed that the disparity between population figures and the number of patients on GP’s lists was not due to fraud.
Dr Patrick Burch, Research Fellow at The University of Manchester and practicing GP authored the paper published in the Journal of Epidemiology and Community Health.
He told Michael Addelman at the University of Manchester:
“It is certainly true that there are more people registered with a general practice in England than are estimated to be resident in the country. But our detailed and substantive research shows a plethora of reasons for this – and GP fraud is not one of them.
“We conducted a cross-sectional study and calculated levels of patient registration with English primary care, in relation to census-derived population estimates. We did indeed find an over-registration rate in England at 3.9% or 2,097,101 people – but there was wide regional variability.
“And our findings show quite clearly that high mobility of patients and health need are likely to be the underlying causes of over registrations, not fraud. Higher levels of over-registration were associated with greater proportions of non-White British residents, women, elderly people and higher levels of social deprivation.
“Non-White British populations are more mobile and more likely to move to and from the UK. When a person has left the UK, the practice has no way of knowing this has occurred so the patient will remain registered. Under-funded and overworked GPs are in no position to regularly check the status of each of their registered patients. Female patients, elderly patients and those patients from areas of social deprivation are higher users of health care services. Their association with over registration may reflect lower levels of registration amongst men, younger and more affluent patients.
“If registration levels are incorrect, we argue it would be very dangerous to reduce practice funding. Removing ineligible patients from practice lists is a complex process and it will not lead to reductions in practice workloads.”
However, NHSCFA insists that around £88 million may be wrongly claimed for and are continuing their investigation.
In 2013, Dr Lucia Gibson returned to practise as a GP after winning a six-year-long battle against the General Medical Council and the NHSCFA (then known as the NHS Counter Fraud Service).
It was alleged she had faked medical records and her list contained ghost patients. She was suspended by the PCT from practising as a GP in Surrey, struck off the PCT’s performers list and suspended by the GMC. In addition, she was arrested and held at Staines police station in 2007 as part of the investigation.
In 2009, Dr Gibson was cleared of fraud at the Kingston High Court. The judge said he agreed with the jury’s verdicts and warned the NHS Counter Fraud Service to think “long and hard” before bringing a similar case to court. The GCM also apologised for the length of the suspension and admitted Dr Gibson was treated with “manifest injustice”.
Tragically, as a result of the allegations, along with accruing £180,000 in legal fees, Dr Gibson lost her GP practice.
Dr Gibson’s case is not an isolated incident. Many GPs, midwives, dentists, pharmacists, and opticians have suffered financial and reputational ruin due to mishandled or unnecessary investigations and hearings.
The situation has the potential to get worse. In October 2018, the Government announced that it would commit to tougher action on NHS fraud over the next five years.
New measures to be introduced include:
• a new partnership between the NHS Counter Fraud Authority (NHSCFA) and the fraud prevention service Cifas, allowing NHS counter-fraud professionals to access Cifas data
• more collaboration and data sharing between the NHS Business Services Authority and NHSCFA to identify the small number of pharmacists and dentists claiming payments for services they have not carried out
• the introduction of a new counter-fraud profession in central government, bringing together around 10,000 counter-fraud specialists, including 400 focused on fraud in the NHS
With more focus on NHS fraud, the risk of innocent people being caught up in investigations increases. If you find yourself being subject to NHS fraud allegations, it is imperative you seek legal advice immediately. Having legal representation at investigative interviews and during searches mitigates the risk of allegations of fraud reaching trial. For the sake of your reputation, finances, and health, it is crucial that you invest in the support to have an NHS fraud investigation shut down as quickly as possible.
Tanveer Qureshi is a Legal 500 barrister, specialising in fraud, ASA compliance, business to business fraud, sanctions, health and safety, food standards, civil litigation, and corporate crime. If you require legal representation, please contact directly on 020 3870 3187.