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Ailing health service losing £44m a year to cross-border cheats

By Victoria O'Hara

More than 400 cross-border health fraudsters have been struck off GP registration lists in Northern Ireland over the past 18 months, a new report has revealed.

Health service fraud is estimated to be costing at least £44m to frontline services here.

The Department of Health report said among the culprits abusing the system were patients from outside Northern Ireland claiming free healthcare they are not entitled to, false claims for prescriptions, or staff forging time sheets.

With a budget of £4.4bn, even a fraud level of just 1% represents a massive £44m disappearing from the ailing health service.

However, research indicates that an organisation generally loses an estimated 3%-5% of its annual budget to fraud.

Among the cases highlighted by Counter Fraud Services (CFS) was an individual trying to register with two different GPs in order to obtain additional medication.

The person was convicted in court and given a six-month sentence suspended for two years.

Another involved a 58-year-old woman from Enniskillen being removed from the GP registration list after a whistleblower reported that she actually lived in Donegal.

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.

Since April 2013, CFS recovered £76,229.59 as a result of random patient verification checking.

The report also highlighted the case of a 52-year-old man who falsely claimed to be exempt from dental charges.

Following a random check, he now has to pay back £297.

However, he was not alone.

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

This led to 8,000 cases being referred for further examination. Patients were written to, seeking proof of entitlement and seeking recovery of the money, or else they were taken to court.

The CFS revealed that in the last 18 months more than 432 people have either been be struck off GP lists or are being examined for accessing free healthcare here despite living outside Northern Ireland. This could save taxpayers £4.6m in five years.

Health Minister Jim Wells said: "Fraud affects us all. All organisations suffer as a result and the health service is no exception. Every penny lost to fraud means less to spend on frontline services."

Factfile

Examples of fraud by patients include:

  • Falsely claiming to be resident in Northern Ireland to get free HSC treatment;
  • Falsely claiming eligibility for free or reduced dental and ophthalmic costs;
  • Altering or using aliases to get prescription drugs.

Examples of fraud by staff:

  • Submitting timesheets for hours not worked
  • Submitting travel claims for inflated milage or journeys unrelated to work

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