Comment

15.08.18

The NHS is not an easy target

Source: NHE July/August 2018

Helen Vernon, chief executive at NHS Resolution, talks about a recent court case which firmly demonstrates that there is no space for contempt, dishonesty and fraud in the NHS.

As with all NHS organisations, the risk of fraud is a significant concern for NHS Resolution. The nature of our work inevitably focuses attention on the risk of fraudulent claims being brought against our members, and we take a zero-tolerance attitude towards fraud while ensuring that legitimate claimants are compensated fairly.

It is estimated that fraud, bribery, and corruption affecting the NHS cost the public purse £1.25bn a year. This is enough money to pay for over 40,000 staff nurses, or to purchase over 5,000 frontline ambulances.

Fraud against the NHS means that taxpayer money intended for patient care ends up in the pockets of those who are not entitled to it. It means fewer resources are available to be spent on frontline health services such as patient care, facilities, doctors, nurses, and other staff. 

NHS Resolution responds firmly to any case where we suspect exaggeration or fraud and we deploy a number of techniques to do so, working closely with partners such as the NHS Counter Fraud Authority. We have adopted tried-and-tested techniques utilised by the insurance industry. For example, we receive over 4,000 claims every year from the NHS which have nothing to do with clinical treatment and arise from injuries to NHS employees or members of the public, such as slipping on ice in a hospital carpark.

When a ‘non-clinical’ claim like this comes in, it is assessed against a checklist of ‘fraud indicators’ in order to validate the claim. If there are suspicions, it will be passed onto our fraud team for investigation. Indications of a potential fraud could range from evidence of previous dishonest behaviour by the claimant, evidence of claims for a similar accident, or a delay in reporting the incident.

For all claims, our investigations may take a number of routes legally available to us from open-source material searches, such as looking at social media profiles or using surveillance if we have concerns. When authorising surveillance, we always consider the privacy of the surveillance subject and the risk of intrusion before proceeding, and there must be a strong justification – such as a medical expert reporting that the injury displayed is not credible.

While it is very rarely used, surveillance helps to protect the public purse from paying unreasonable or unjustified levels of compensation. One example of a recent landmark case where NHS Resolution pursued action, which ultimately resulted in the imprisonment of the fraudulent claimant, was that of Sandip Atwal. 

Atwal, from Huddersfield, went to hospital for injuries to his hands and lip after being attacked in 2008. He said the treatment he received had left him unemployed and dependent. Fractures of two fingers and a laceration of the lower lip were negligently treated. In 2011, Calderdale and Huddersfield NHS FT offered £30,000 to settle the case, but this was not accepted.

However, over the next five years, Atwal systematically fabricated and exaggerated his claims. His schedule of loss of £837,109 included very substantial sums for future care and loss of earnings, on the basis he was unable to work and grossly incapacitated.

The trust’s legal team were suspicious as his claimed disabilities were inconsistent with entries in the contemporaneous medical records. Covert video surveillance of Atwal in 2015 exposed him working and lifting heavy items, using his phone, and driving with ease. His social media posts also showed him working as a DJ – under the name Sunny KMS – including featuring in a music video.

On 27 April 2018 Atwal was found guilty of 14 counts of contempt of court, and on 1 June, following an application on the instructions of NHS Resolution and the NHS trust, he was jailed for three months.

The case sends a strong message that the NHS is not an easy target, and fraudulent claims cannot be submitted with impunity. We will properly examine all claims that are presented to us and where there is a legitimate claim, we will pay an appropriate level of compensation. However, where we believe a claim to be fraudulent, NHS Resolution will always investigate and pursue action to its ultimate end, which could mean prison – regardless of the size of the claim.

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