Physiotherapists can get caught up in insurance scams. Colin Jemide describes how to spot the fraudsters.
The Insurance Fraud Enforcement Department (IFED) is a specialist police unit that investigates serious, organised and opportunistic insurance fraud across England and Wales.
The IFED has seen a recent increase in cases of exaggerated claims and over-invoicing by those involved in fraud. These claims are often for minor soft-tissue injuries such as whiplash, or medical costs, loss of earnings and rehabilitation care linked with road traffic accidents.
Cases include claiming for physio sessions that were not actually provided or where the number of sessions was exaggerated. Sometimes there is complicity with claimants. The most recent high-profile case was that of a doctor, Benjamin Chang, who submitted false claims for numerous physio sessions never carried out.
This type of fraud is normally facilitated by professional ‘enablers’ who can be broadly described as those misusing expertise to facilitate fraud and who are engaged in the provision of services as part of the claims process. They can play a key role, wittingly or unwittingly using their professional standing to give claims the appearance of legitimacy.
Insurance companies are also seeing a rise in corrupt examiners preparing medical reports for a person they have not examined in return for a fee. In some circumstances a doctor’s details have been used fraudulently, which is where private-practice physiotherapists need to be aware and take precautions.
The advice from the IFED to physiotherapists in private practice centres on ensuring due diligence;
- put systems in place to check that reports are not altered after being submitted,
- report instances of requests to sign suspicious documents or blank invoices,
- be vigilant of report templates being used for fabrication of false physiotherapy sessions,
- put measures in place to prevent professional identities being stolen,
- be aware of the implications and dangers of being complicit, unknowingly or knowingly,
Finally, practitioners should remember their professional responsibilities, including the duty to adhere to legal and regulatory requirements, and to act with integrity, honesty and openness.
- Colin Jemide, prevent adviser, Insurance Fraud Enforcement Department, City of London Police
AuthorColin Jemide, Prevent adviser, Insurance Fraud Enforcement Department, City of London Police
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