A leading private health insurer has revealed corrupt doctors and hospitals are costing the private health sector millions of pounds in fraudulent claims.
According to Norwich Union Healthcare, the main offenders are hospital consultants, who are carrying out private work and charging too much for it. This has involved lying over the complexity of the treatment and in some cases carrying out unnecessary and costly procedures.
One such case involved a consultant gastroenterologist, Navneet Ahluwalia, of Cheadle in Greater Manchester, who had racked up a total false claim of £85,000 from various different private health insurers.
In another incident, a consultant gynaecologist, Christopher Hutchins, from Nuneaton, went as far as submitting claims for operations that would have been physically impossible for him to perform - as the body parts had already been removed!
This has very serious repercussions for patients and for the private health sector, and although there were only a minority of doctors involved, patients’ premiums are steadily rising because of it.
Norwich Union’s appointed director of health care, Simon Arnold speaks about their new anti-fraud system put in place to tackle the problem, with improved monitoring to identify strange patterns of payment and uncover false claims that may have not shown up in the past. He said,
“We want to try to stamp out the abuse. We are talking about £100 here and £50 there that builds up over time, not just the £10,000 fraud. It is time for us to make a concerted effort and now we are able to spot the patterns.”
Hutchins tripped up when he continually claimed for treatments he had not done as well as splitting procedures into individual claims and thus receiving a fee for each - one occasion claiming up to 22 times for a procedure which should have been filed just once.
In 2003 the General Medical Council called for a disciplinary panel to investigate Hutchins - he was found guilty of being dishonest and untrustworthy, banned from the medical register and asked to re-pay the tens of thousands of pounds he had falsely accrued.
In addition, Ahluwalia, was discovered to have been using higher claim codes for far more complex procedures than he had actually performed. The example cited involved him claiming for a surgical procedure when in fact it only involved a camera being inserted into the stomach, down the throat. He was suspended from the medical register for one year in March 2008 following another disciplinary panel. The fraud occurred at his private practice in the Alexandra Hospital in Cheadle - he defrauded Bupa of £32,000, Axa of over £22,000, Norwich Union of £15,573 and Western Provident Association of £13,937.
Jim Gee, KPMG’s director of fraud has been employed by Norwich Union to head up their anti-fraud team. He has a glowing past record having taken a leading role in helping the NHS recover over £800m in fraudulent claims.
The most worrying aspect of this rising problem is the effect it is having on the patients. In some more extreme cases, patients were subjected to unneccessary and often painful procedures. For example, non-cancerous lumps being removed in order to claim for the expensive surgery.
