Over 100 NI patients faced court accused of cheating NHS
Dishonesty and system errors cost taxpayer more than £3 million
More than 100 patients in Northern Ireland who underwent dental and eye care treatment ended up in court after many were accused of cheating the NHS. Photograph: Rui Vieira/PA Wire
Dishonesty and mistakes in the system cost the taxpayer just over £3 million (€3.6 million). One GP and two dentists were investigated for suspected fraud, the report revealed. A dentist was referred to the General Dental Council and another faced civil legal proceedings.
The scale of the fraud was disclosed in a paper compiled by Department of Health experts. More than 5,000 cases where exemption from charges was claimed were investigated but only £43,000 was recovered.
Neville Jones, an assistant director at the department’s anti-fraud service, said: “Fraud is the theft of health service resources. As such, by any definition or yardstick, it is quite simply wrong.
“Fraud is not a victimless crime and effectively reduces the level of availability of resources for the delivery of patient care.”
People on certain benefits or with some chronic medical conditions can claim exemptions from charges for dental or eye treatment.
During the financial year ending in March, more than 33,000 treatments were checked where exemption from charges was claimed, said the annual report of the Counterfraud and Probity Services Operations Directorate.
This resulted in 5,015 cases being further investigated, and £43,047 was recovered.
A total of 107 cases of suspected fraud or error were won in the small claims court by the health service.
A very detailed and complex investigation led to the successful prosecution last year of two directors of a company delivering mobile eye services. Both were given suspended prison sentences. A repayment of around £40,000 was made to the health board.
Two pharmacies under investigation were also ordered to repay more than £31,500.
Wrongful claims also involved making false declarations to avoid paying for care provided by health service “contractors” such as GPs or to avail themselves of hospital services.
One man who was living abroad but treated in Northern Ireland owed the NHS £27,000. He was married to someone who lived locally, had spent a period in the region and had been registered with a GP, the gateway to hospital services.
He moved to the US but returned for free health care.
Other fraud involved incorrect staff expenses claims - for example nurses who travel to visit ill people in the community may claim for journeys not taken or hours not worked.
Business Services Organisation (BSO) chief executive David Bingham noted a correlation between fraud levels rising and the recession, adding that the service had increased the size of its specialist team.