Health insurers reveal court cases in the fight against fraud

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Health insurers reveal court cases in the fight against fraud

The Health Insurance Counter Fraud Group has revealed two recent cases demonstrating the progress of cooperative work across the health insurance and dental industry to combat fraud.

Andrew Baxter

Andrew Baxter, 54, of Fareham in Hampshire was found guilty on five counts of fraud, including one count of fraud by false representation, at Hammersmith Magistrates' Court on 28th January 2016.

The Court heard that he had submitted a number of low- value fraudulent claims as a policyholder over several months.

He was caught when a member of the Health Insurers Counter Fraud Group became suspicious.

Under the data sharing arrangements insurers have in place, a number of insurers found they had paid the same claims. Insurers involved included Westfield Health and WPA. 

Baxter was also found to have used a number of aliases when taking out insurance policies, including variations of Andrew Dean Eviston-Baxter.

Baxter was fined £750 and ordered to pay £1,200 towards the prosecution's costs. In addition, he was ordered to pay the "victims' surcharge" at the level of £20.

This judgement enables the victims to now seek recovery through civil claims against Mr Baxter.

Mark Walewski

In a separate case five insurers provided evidence to assist an investigation led by NHS Protect of dentist Mark Walewski who was sentenced to three years imprisonment.

Walewski defrauded the NHS of £223,000 on over 6,600 fraudulent claims between 2006 and 2012 at the New Dental Surgery in Hindhead, which he later sold.

Walewski, a motorsports fan, filled his garages with Ferrari and Lotus cars, and enjoyed the comforts of his large house and garden.

The dental surgeon would have had a high income even without crime: he built up his NHS contract to over £340,000 a year.

An anonymous tip-off was received that for years, Mr Walewski had been charging patients privately and billing the NHS for the same treatment

Mark Walewski, 68, of Tilford Road, Churt, Surrey, had earlier pleaded guilty to 2 counts of fraud by abuse of position and 2 counts of evasion of a liability by deception. He was sentenced to three years imprisonment at Guildford Crown Court on 1st February, 2016. 

Walewski carried out the following false claims: 

• ‘double claiming' (charging the patient privately but making a claim to the NHS as well)
• ‘up-coding' (claims were submitted for exempt (fully NHS-funded) patients for treatments of a higher value than were actually carried out.
• Walewski also submitted claims for prescriptions that had never been issued to patients.
• a large number of these frauds related to children, including an infant too young to have teeth

Dr Simon Peck, chair of the Health Insurance Counter Fraud Group, said: "We were one of the first industries to institute cooperative working in the fight against fraud. 

"We are fortunate in that the vast majority of our customers and suppliers are honest but where we do find evidence of wrongdoing, we will take action to protect our customers' premiums and we are committed to working collaboratively with our competitors and other agencies to that end."

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