General practitioners (GPs)

Examples of fraud committed by healthcare providers are numerous and have been divided into further categories: General practitioners; Hospitals; Other healthcare providers (dentists, ophthalmologists, etc;)

GP declares sickness leave whilst working in private practice (UK)

A GP in England was sentenced to 12 months imprisonment for falsely claiming to be off work sick, whilst continuing to work in  (UK) a private practice. The National Health Service (NHS) paid for his surgery to receive locum cover during his alleged period of sickness. In fact, during this time the 47-year-old doctor worked for private companies and health insurers.

In addition to this, it was discovered that the GP also stated that his wife was employed at his surgery, which resulted in the NHS paying her salary. This was found to be completely false as she had never worked at the surgery.

GPs prescribed for an amount of over €40,000 but no patient got any medicines (Spain)

Four doctors, four pharmacists and one pharmaceutical representative were involved in a case of fraudulent prescriptions that amounted to more than €40,000. The primary healthcare doctors wrote prescriptions in the name of elderly patients they had visited in the same primary healthcare centre. However no medicines were prescribed to any patients and no patient ever received them.

Instead, the doctors would give the prescriptions to the pharmaceutical representative who would in turn fill in the prescriptions with high cost medicines produced by the laboratory he represented. The representative would then give the prescriptions to the pharmacists, who would then invoice the medicines to CatSalut, the Catalan Health Service. A total of 557 fraudulent prescriptions were found, representing an amount of €42.910,4.

GP involved in drug traffic (France)

Independent doctors in France are free to prescribe the drugs they see necessary; there is no a priori control in accordance with diseases. In this case however, suspicion arose as inconsistencies were noticed in the prescribing habits of a doctor. He prescribed treatments involving several drugs, although most of the drugs had the same indications and similar characteristics. One treatment involved up to seven different drugs with similar characteristics prescribed for one same disease. Further prescriptions concerned drugs for the treatment of diabetes for example, which had been written without previous blood tests or without previous medical exploration. An anti-inflammatory drug treatment had also been prescribed without any further medical explorations. The “over-consumption” of drugs represented more than 1500 boxes of drugs and an amount of €22,920 for six patients.

GP prescribes over 2500 fraudulent prescriptions (France)

A General Practitioner invoiced prescription formsfor consultations and visits to patients who benefit from CMU (law introduced in France to ensure free healthcare for people on low income, who have no social security cover), during non working days and holidays. These prescription forms were not related to drug prescriptions.

The investigation found that 2,503 false acts had been committed over a 15-month period; the financial harm was assessed to be more than €60,000.