You Too Could Fall Foul Of Claims Rules, Warns MDDUS, Scotland

Main Category: Health Insurance / Medical Insurance
Also Included In: Litigation / Medical Malpractice;  Primary Care / General Practice
Article Date: 27 May 2009 - 4:00 PDT

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It's not just MPs who can make inappropriate claims for recompense or misunderstand the rules, warns the Medical and Dental Defence Union of Scotland (MDDUS).

The current political climate means MPs are more in the firing line than doctors - but the MDDUS still knows of cases where GPs have fallen foul of employers or regulators over inappropriate or ill-informed fee claims, which had to be repaid. One GP was struck off.

QOF payments and claims for temporary residents are the two main potential pitfalls.

"While most GPs are scrupulously honest, in the current economic circumstances, some may be tempted to boost income with claims that surf the line between the creative and the fraudulent," says Dr George Fernie, head of the medical division of the UK-wide MDDUS.

"We strongly urge them to resist. The GMC has firm views - and rightly so - on GP probity."

The MDDUS has cases on its files of GPs who failed to look closely enough at whether new patients should be registered, claiming for them as "temporary". They repaid (often derisory) fees, but the doctors concerned were still referred to the GMC and given warnings.

A doctor was erased from the Register in January 2009 for falsifying QOF figures. The MDDUS has also heard of a tiny minority of practice principals conspiring to "massage" QOF points.

Speculative claims may be picked up by the NHS Counter Fraud Service, random QOF reviews or Payment Verification Visits. The GMC's Good Medical Practice says that being honest and acting with integrity is integral to medical professionalism. As a GP, "you must make sure that your conduct… justifies your patients' trust in you and the public's trust in the profession".

"If in doubt, ask yourself: would my actions withstand public scrutiny?" adds Dr Fernie.

Source
Medical and Dental Defence Union of Scotland

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