Northern Ireland’s health services lose €55m to fraud

At least £44 million (€55m)was lost to frontline health services in Northern Ireland because of fraud last year, officials have said.

Patients from outside Northern Ireland falsely claiming free care, prescription fraud and false claims for exemption from dental and eye care charges were among the culprits, the NHS said.

Some staff abused sick leave or misused health resources for personal gain, according to a report.

A woman from Donegal was on the GP register in Enniskillen until she was reported by a whistleblower.

In the last 18 months, more than 33,000 dental and ophthalmic treatments were checked where exemption to health services charges were claimed.

This led to more than 8,000 cases being referred for further examination and 124 patients were pursued through the courts.

The review by the health service said: “The current process is unfortunately being abused by a minority of patients.”

Research

Research indicates that an organisation loses an estimated 3-5 per cent of its annual budget to fraud.

The health and social care system has a budget of £4.4 billion. At a conservative estimate of 1 per cent, this would mean that £44 million is lost to frontline services, the review said.

This can be a direct result of fraudulent activities either by staff or patients, such as staff submitting false time or travel sheets.

The NHS is taking a range of steps to target dishonesty.

This is International Fraud Awareness Week. Counter Fraud services established a new team in June last year which focuses on access to healthcare.

Members are tackling cross-border health fraud — patients living in the Republic accessing health services in Northern Ireland for free when they are not entitled.

In the last 18 months, this team – together with an investigative unit — has removed, or referred for removal, 438 patients from a GP registration list.

This will contribute to a projected saving of £4.6 million over a five-year period, the report said.

It added: “As a result of a recent proactive project aimed at tacking cross-border health fraud, the team were able to identify 82 per cent of respondents were not entitled and have been removed for our lists.”

The investigations team has a 96% conviction rate for cases processed through the courts. In the last 18 months, it has secured 28 convictions for a range of fraud-related offences.

In one case, a nurse submitted false time sheets and forged her manager’s signature and the team recovered £25,000, which has gone into paying for frontline services.

The woman was sentenced to a year in prison, suspended for three years.