Posted and filed under Fraud, FWA, Healthcare, Waste.

Friend of Advize Dr. Simon Peck kindly stepped in as guest blogger this week to discuss healthcare fraud from an international perspective.

Last month, the biggest health story in the United Kingdom was not about coronavirus but the conclusion of the long-awaited inquiry into breast surgeon Ian Paterson, who is currently serving a 20-year jail term for the malicious wounding of patients. I played a small part as one of many witnesses who gave evidence at the inquiry.

The report which can be read here, makes for painful reading and there may be more bad news to come. At the request of the police, a second coroner’s inquiry has just been opened into deaths of patients under his care.

This is not just a story of a rogue surgeon but rather the story of a complete failure at all stages of a healthcare system that is supposed to protect patients.

At the center of the story, was a surgeon who performed unnecessary operations (presumably for money) on patients who thought they had cancer but who also performed incomplete mastectomies, putting patients who did have cancer at risk of recurrence. But there was also:

  • Independent and public (NHS) hospitals that failed to adequately supervise him, institutions that appeared to be more concerned about preserving their reputations than the safety of patients.
  • A culture within the health service of denial, cover-up and willful blindness.
  • Ineffective regulators who dismissed patients’ concerns.
  • A doctors’ personal indemnity insurer which used its discretion and legal argument to deny compensation to victims until a class action forced all parties to settle.

We might not have even heard about this had it not been for a group of courageous women determined to not to let others suffer as they had; who pushed for an inquiry and for whom I have the greatest respect and admiration.

In parliament, politicians have been lining up wringing their hands and speaking of lessons learned. And the regulators say there are now new safeguards to prevent this from happening. But many of the witnesses in the hearing, including myself, do not believe this to be the case. We have been here before. Many times. As anyone who follows the UK health system knows – we have had a series of scandals: the Bristol Heart Surgeons, Mid Staffordshire, Gosport Memorial Hospital, Morecambe Bay, to name a few. Many of the same themes have emerged and lessons have not been learned.

The health regulatory system in the UK is fragmented and unfit for purpose. I have seen this firsthand as I have referred a number of serious matters and have almost always been stonewalled by bureaucratic organizations with, it seems, an endless catalogue of excuses to justify doing nothing. I have referred kickback schemes, bogus cancer treatment, alleged fraudulent billing and other serious matters to the General Medical Council and none were investigated.  I do not mean the GMC investigated and ruled that there were no issues. I mean they declined to investigate at all. When I appealed to the Professional Standards Authority, which is supposed to regulate the GMC, they informed me that, “A decision not to investigate is not defined as a decision for the purposes of our remit,” which means they won’t look at it. On two occasions I wrote to government ministers whose reply was “Ministers cannot comment on individual cases”. Pandora’s box remains firmly closed.

I am afraid that whilst there have undoubtedly been some improvements over the past few decades, similar cases can and will happen again. Patients will not be safe until our fragmented and ineffective regulatory system is reformed.

Dr. Simon Peck is a physician who specializes in the investigation of Fraud Waste and Abuse in Domestic and International Health Funds. This is a personal view not that of any organization with which he may be associated.