AXA PPP healthcare has settled a claim with a consultant plastic and reconstructive surgeon following an investigation into mis-billing, reclaiming over £100,000.
The insurer revealed it had accepted a settlement in excess of £100,000 plus legal costs from consultant surgeon Ciaran Healy.
This relates to mis-billing for treatments Mr Healy was providing at private clinics including the Wellington Hospital in London.
The claim was settled without admission of liability in advance of proceedings being issued in the High Court.
AXA PPP healthcare undertook an audit of the Healy's billing practice which revealed a pattern of billing which did not appear reflective of the level of clinical intervention expected or required.
There had also been a number of charges for an unexpected and unexplained number of additional services.
Dr Simon Peck, head of investigations at AXA PPP healthcare, said "We work hard to protect customer premiums by ensuring that medical treatment is billed to us correctly. Most of the billing we receive is entirely reasonable but some is not.
"We use analytics to identify anomalies which we then investigate. In addition to this case we have also this month seen a number of other significant financial settlements achieved by negotiation with providers and their legal representatives; demonstrating the continuing success of our Provider Investigations Team."
A spokesperson for AXA PPP said of the case's timeline: "We noticed that the pattern of billing looked unusual both in types of treatments and the frequency of some additional services which were charged. This led us to make further enquiries which involved looking at treatment records, speaking to patients and obtaining external advice.
"AXA PPP's enquiry started in mid 2012. In early 2013 we corresponded with Mr Healy. This continued until mid 2013. In January 2014 we notified him of our estimated losses at which point he engaged a legal representative.
"We notified Mr Healy's representatives in February 2015 of our intention to file the claim at court. We had proposed to file the claim on 1 April 2015 and subsequently received a request by Mr Healy for negotiation and the matter was settled in late May 2015."
AXA PPP also confirmed the insurer had "suspended our recognition of Mr Healy."
