U.S. health board rubber-stamps CEO ‘corruption’

Board members at MetroHealth Medical Center in Cleveland, Ohio, USA, are wondering how they missed several warning signs that something was wrong with the conduct of former executive John Carroll.

Carroll pleaded guilty earlier this month to taking more than $600,000 in bribes over nearly 10 years in exchange for inflated construction contracts that the board approved.

According to Rick Wade, a spokesman for the American Hospital Association’s Center for Healthcare Governance, communities in the USA have raised their expectations of hospital boards and expect them to demand the necessary information from management so the trustees can properly oversee operations. “Overseeing and managing a hospital has become ever more complex,” Wade said. “You are in command of a huge amount of community resources that have to be spent wisely.”

As reported on www.cleveland.com a few of the trustees of the board of MetroHealth Medical Center are grappling with how they missed the signs. “You depend on one another. What you don’t know, you hope that somebody else can figure out,” said Polly Clemo, who has been on the board since 1995. “I don’t know that we knew what to ask,” she added.

For further information on this story, click here.

Hospital boss wrongly accused of fraud says bungled police investigation has wrecked his life

Readers may recall a recent post criticising both the NHS counter fraud service and police following the collapse of a fraud trial involving the former CEO of a private hospital group (click here).

The Telegraph (26 August 2009) picks up the story of how the former hospital CEOs life has been “wrecked” following the “bungled investigation” of a “malicious allegation.”

According to the Telegraph article, the former hospital CEO, “Mr Breeze, 54, found himself under arrest after a member of staff going through a disciplinary procedure accused him and two colleagues of defrauding the NHS out of £2.5 million at the privately-run Cawston Park psychiatric hospital near Norwich by overcharging for services.

Mr Breeze said there was no substance to the allegation but accused Norfolk police of setting out to “establish guilt rather than the truth, to construct a case rather than impartially investigate a suspected crime”.

Concerns have been raised in the past about the methods employed by, and the apparent lack of accountability of the NHS counter fraud services. Given the collapse of the fraud trial involving Mr Breeze, Healthcare Governance Review strongly advocates an independent review of the methods adopted by NHS counter fraud services, together with the conduct of the police involved in the investigation. The review should cover all cases since the establishment of the NHS counter fraud service that have not resulted in conviction and should include cases that have not gone to court.

Read the Telegraph article here.

NHS Counter Fraud Service slated after trial collapses

As reported in the Health Service Journal (HSJ – 25 June 2009), the former chief executive of a private hospital group has criticised the NHS Counter Fraud Service and police after his trial for fraud collapsed.

Andrew Breeze, and former finance director Dominic Wilson of  Norfolk, were found not guilty of conspiracy to defraud the health service of more than £2m, at the direction of a judge at Ipswich crown court.

The Crown Prosecution Service had said earlier it would offer no further evidence.

Mr Breeze said the investigation into the case had been incompetent and had assumed he and his co-defendant were guilty.

He said the cost of the three year investigation and seven week trial was likely to be several million pounds.

Mr Breeze, a former board member at a mental health trust with 30 years’ NHS service, said he hoped to return to work in the psychiatric sector.

David Prior, chair of Norfolk and Norwich University Hospitals foundation trust and former chair of Chancellor Care, said the two men had been through three years of utter misery.

Mr Prior was himself investigated by police but not charged. He stood down temporarily as Norfolk and Norwich chair during the investigation.

“It’s a tragedy that it was allowed to get to court,” he said.

“Before the prosecution case was even finished they had to give up.

“People who have not been through this process can have no idea how debilitating it is.

“It is shameful that it was allowed to happen.”

Read the full HSJ article here.

NHS fire and risk assessment officer fined for fraud

Accirding to the Manchester Evening News (30 January 2009), an NHS fire and risk assessment officer has been sacked and ordered to pay out more than £5,000 after falsely claiming travel expenses.

Mark Ashton cheated East Cheshire NHS Trust out of more than £1,000 by claiming mileage for made-up journeys.

Ashton, 50, of London Road South, Poynton, who had worked as a fire and risk assessment officer for the trust since 2001, admitted fraud by false representation at Macclesfield magistrates court.

He was given a 12-month conditional discharge and ordered to pay back £1,181 in compensation and more than £4,000 in costs.

For further information, click here.

NHS Primary Care Trust director jailed for CV lies

According to www.publicservice.co.uk (the information portal for the public sector, 7 January 2009) Stoke-on-Trent Primary Care Trust (PCT), now NHS Stoke-on-Trent, made Lee Whitehead its new director of planning and modernisation but had to sack him when they found out that he had lied on his curriculum vitae (CV) about having a Master’s degree and a doctorate. Not only did Whitehead lose his £78,000-a-year job, but he has also been sent to prison for 12 weeks after the Department of Work and Pensions decided to take the matter to court.

According to a report in the Stoke-on-Trent Sentinel newspaper, Whitehead said in November 2006 that he had a first class science degree, a post-graduate science degree, a PhD in psychology, and that he was a member of the British Psychological Society. The only truthful statement was that he had a science degree but it was second class. The irony is that none of these made up qualifications were needed for him to get the job.

Paul Kay, prosecuting for the DWP, said: “The post-holder was not required to hold either a Master’s or a PhD, or be a member of the BPS. But clearly these assisted him in getting the job.”

It wasn’t any checks made by the PCT that brought Whitehead’s lies to light but another member of staff who was suspicious about his qualifications. When the PCT then challenged Whitehead he failed to provide any proof and the bodies he said he studied at and was a member of had no record of him. The court heard Whitehead had told the same lies to get his previous job with another PCT.

A spokesman for NHS Stoke-on-Trent said their selection procedures had been tightened up, adding: “We weren’t the first organisation Mr Whitehead made his irresponsible claims to. People can be assured that we have strict checks in place to ensure that all our staff are qualified to do their jobs.”

NHS funds fraudulently used to import horse sperm?

According to an article in The Independent on Sunday (7 December 2008), police are investigating an allegation that a hospital manager imported equine semen for her stud farm, claiming it was for human IVF treatment.

Louise Tomkins (45) was employed as a senior general manager at the Imperial College NHS Healthcare Trust in west London. It is alleged that she diverted NHS funds to buy horse sperm that was then used to breed mares. Ms Tomkins was arrested by police and was bailed. It is understood that she recently left the trust, which she joined in 2004.

According to The Independent on Sunday, “NHS trust sources said police were alerted after internal audits revealed an unusual series of large purchases of human semen from overseas suppliers. Invoices said to be worth several hundred thousand pounds had allegedly been created to account for the transactions. When these were later checked it appeared that the companies had supplied thoroughbred horse sperm.”

Assuming the allegations are found to be true, this will have to go down as one of the most unusual frauds carried out by a manager in the NHS.

Readers might like to be reassured that “NHS trust sources…..stressed there has been no suggestion of any horse sperm being improperly or inadvertently used in the trust’s IVF treatments.”

Read the full Independent article here.

NHS fraud: What fraud?

The Health Service Journal reports on fraud in the NHS and, in particular, the role of the NHS Counter Fraud Service (click here for article). A key focus of the article is the case involving Philip Neal, former finance director at Mid-Essex Hospital Services trust (read Healthcare Governance Review post here).

Of interest in the article are the examples of NHS fraud, mostly coming from primary care and which include:

- Conspiring with a GP, a pharmacist submitted bogus prescriptions for reimbursement with a value of more than £1m.
- A dentist claimed £212,000 over two years by submitting claims for patients who did not exist.
- A dentist made duplicate claims for patients, making slight changes to their names, with a total value of more than £70,000.
- A dispensing GP issued bogus prescriptions for residential home patients over several years, with a value of more than £700,000.
- One GP’s claims for night visits rose from fewer than 200 visits per year to 500, but the additional visits had not been made.
- A senior specialist falsified employment agency timesheets, which generated £46,000 over five years.
- An investigation into one NHS trust revealed more than £380,000 in claims for duty payments and hours worked, with no evidence that the work had been done.

However, the NHS Counter Fraud Service has come in for significant criticism since its establishment in 1999 when Jim Gee, a keen Labour Party supporter, was directly appointed by the then Minister of State for Health, Alan Milburn, as NHS ‘fraud supremo’. Of particular concern was the figures being bandied about by Jim and his team of possible fraud levels as much as 3-8% of the entire NHS budget. In reality, NHS fraud is estimated (in 2006/07) at around £70m, equivalent to less than 0.1% of annual budget. Subsequently, concerns arose about the methods employed by Jim Gee and his team, some of which, such as fishing for fraud, are referred to in the HSJ article. Jim Gee chose to leave his ‘fraud supremo’ post in 2007 in favour of a commerical role with a major accounting firm.

As far as Healthcare Governance Review is concerned, the key to good fraud control in the NHS is not about having an army of ‘frauditors’ such as the Counter Fraud Service going around ‘fishing’ for issues. Rather, it is about Directors of Finance having effective fraud controls in place within their organisations, backed by independent internal audit. These are the measures that have undoubtedly kept fraud to a level of less than 0.1% of budget in the NHS. There is plenty of spin around estimates of fraud savings, but no hard evidence that suggests the Counter Fraud Service adds real value beyond existing controls in the NHS.