Based in the Central Services Agency, the Unit has a dual remit: tackling fraudulent claims to exemption from charges and investigating cases of potential or suspected fraud involving practitioners. In carrying out this work the Unit will be building on work that was previously done within the Family Practitioner Services Directorate in the Agency for many years.

EXEMPTION FRAUD

Part of the exemption fraud work within the Unit involves verifying whether the exemption claimed by a patient is valid or not. Where there is no entitlement to the exemption claimed, the monies involved are recovered from the patient. In recent times as part of this process over 50 cases have been successfully pursued through the Small Claims Court. The Department of Health, Social Services and Public Safety have planned a major development in this area in the coming year with the introduction of fixed penalty charges for those who claim exemptions to which they are not entitled. The levying of such fines will fall to the CFU to administer.

PRACTITIONER FRAUD

Working with colleagues in Boards, the Agency and the Police, it will be the Unit’s job to seek to establish whether fraud has taken place. This can involve very detailed analysis of a range of documents such as prescription and payment claim forms; taking witness statements, conducting taped interviews with individuals under caution, surveillance (where necessary), preparation of papers for court proceedings and attending and giving evidence in court.

THE WAY FORWARD

To successfully tackle the problem of fraud within the Family Practitioner Services the CFU is working in partnership with colleagues in the Central Services Agency, the Health Boards and the Department of Health, Social Services and Public Safety. But the Unit is also keen to work with any individual who can help bring such cases of fraudulent practices to light. Everyone has a particular role to play, and it is only by harnessing all these efforts that substantial and lasting progress can be made. If we can work together successfully, then it will ultimately be patients who stand to benefit through additional resources being available for healthcare.