Consultant Fraud and the Health Insurance Counter Fraud Group
All private medical insurers and AXA PPP in particular are continuing to act firmly against consultants whom they “suspect” of fraudulent activity. The FIPO position on this is clear and neither we, nor indeed anyone in the profession can condone fraud. However, because AXA PPP is taking such a rigid attitude, several colleagues have been threatened with de-recognition or actually de-recognised.
The FIPO advice, at the moment, is for consultants to take particular care in their approach to billing procedures. At all times we recommend reasonable fees and there should be no unbundling of procedures. However, there are a number of coding anomalies that have been brought to our attention through various consultants in different specialities and these could be contributing to the difficulties. We will be trying to iron out these problems with a Hospital Coding Liaison Group and then presenting our views to the insurers.
Eleven private medical insurers have now combined in a group known as the Health Insurance Counter Fraud Group (HICFG), which has developed a centralised database to record fraudulent activity. This database is new to health insurance but standard practice in other insurance markets. It is permissible under the Data Protection Act for insurers to share information about possible fraudulent activity. HICFG is primarily directed against dubious subscribers but will also carry information about brokers and consultants. Liaisons have been formed between HICFG and the police and other authorities and the GMC has also engaged and is trying to standardise methods by which possible fraudulent doctors can be reported.
FIPO has met with the Chairman of HICFG and we are assured that there is no intention to carry out any persecution of consultants. However, FIPO has also been shown some rather gross examples of poor billing (deliberate or otherwise) and some unacceptable examples of unbundling of procedures. Colleagues that do this bring everyone in to disrepute and cause problems for their patients. The message is to be clear and transparent with both the patient and the insurers. Patients should be warned of their likely fees and if in doubt all these issues should be clarified with the relevant insurer.