Saturday, July 13, 2013


This will always be free:

© Am Ang Zhang 2013

As government money is the best money to be made anywhere, England's NHS will soon be giving away your money to privateers who perhaps need not even have to try the tricks they used in the US.

Latest Medicare Fraud  Dallas, Texas, USA.

Federal authorities announced charges Tuesday in the largest healthcare fraud scam in the nation's history, indicting a Dallas-area physician on charges that he bilked Medicare of nearly $375 million and accusing him of sending "recruiters" to scoop up patients and get them to sign for treatments he never provided.

Prosecutors said Roy and his office manager in DeSoto, Teri Sivils, who was also charged, sent healthcare "recruiters" door-to-door asking residents to sign forms that contained the doctor's electronic signature and stating that his practice had seen them professionally in their own homes.
They also dispatched "recruiters" to a homeless shelter in Dallas, paying the recruiters $50 every time they coaxed a street person to a nearby parking lot and signed him up on the bogus forms.

Even when officials suspended his Medicare license last June, they said, Roy found a way around that by shifting his business to another company.

Claims that there is no socialised medicine in the US is unfounded an their expenditure is scary! Yet there are very talented people trying to scam the system and unfortunately that includes doctors that will even do stents and transplants. 

Why can we not learn?

Private providers will not be hovering around if there is no money to be made.

Well, we are literally giving it away:

NHS Vault: Fair Playing Field

In 2007 Circle bought Nations Healthcare and with this came the Independent Sector Treatment Centre (ISTC) in Nottingham and the Midlands Centre in Burton and a facility in Bradford.

The staff who work in the treatment centre are seconded from the University Hospital under a Staff Services Agreement. It should be very clear that the treatment centre is part of the complex and depends on the NHS hospital.

The contract with Circle was extremely generous compared to the NHS hospital a short walk next door. The contract is known as a Minimum Take (MT) contract. Unlike Payment by Results (PbR, the payment system for NHS providers) Circle has a guaranteed income known as the "minimum take" and this means that commissioners pay the treatment centre even if they treat fewer than 95% of the patients they are contracted to treat. Further, the commissioners pay national tariff plus 22% for all activity up to 105% of plan and are paid national tariff for any activity over 105%.

The last full Annual Report from Circle is for the year ending 31 Dec 2011 (pdf). This report states that  the Nottingham treatment centre was the only profitable part of the business. In 2011 it treated 87,340 patients generating revenue of £51.2m. The operating profit was £2,4m. Compare this to the much smaller CircleBath which treated 33,174 patients (both private and NHS) generating revenues of £13.2m and an operating loss of (£9,156k). Clearly Circle are not good at delivering private healthcare. In 2011, the total loss of Circle Holdings was £32.9m.

Most of the 87,340 patients of the Nottingham treatment centre will be treated on "minimum take", so the £51.2m is 22% more than an NHS hospital would be paid. Since the profit is just 5% of revenue, one has to question whether Circle could make a profit at the Nottingham treatment centre if it was paid like an NHS hospital.

The contract for the Nottingham Treatment centre has again been re-awarded to Circle. The contract is for 5 years and the tender advertisement suggests that the contract is worth between £22m and £42m. The tender was handled by Midlands and East SHA on behalf of Principa CCG.

Nottingham University Hospital was one of the original bidders for the tender, and considering it provides the staff, does the same work at tariff, and is right next door to the treatment centre, it would appear to be a no brainer that they would get the contract. Details of the contract are currently not available, so we do not know if Circle will be paid at tariff, or on a minimum take. If the contract is on the former (tariff), then it is difficult to see how the ISTC can make a profit (and difficult for Circle to have a sustainable future). If it is the latter (minimum take) then this will go against government policy of a fair playing field.

Read the full blog here: Fair Playing Field

No full privatisation:
So nobody in their right mind would want to privatise the NHS. There is certainly more money to be made if it remained in the public domain.

For a long time, private providers only have consultants working for them to provide the specialist care. They are now moving into primary care to basically corner the market.

Business is business!!!

But the sums are somehow wrong: if the private providers are making money and the GP commissioning teams have a limited pot and that Consultants working for the likes of BMI hospitals have a 300% increase in pay compared to old NHS Hospital pay scale, either tax payers are going to be forking out more and more money or someone is not going to get their treatment.

Is some politician heading for a top job with the likes of GHG or Bupa? Only time will tell and history told us it won’t be long: less than 2 years.

NHS:  Manipulation or Fraud?

More Health Care fraud like with the US?

In the current push for applying market principles, the NHS is in serious danger of paying dearly for unnecessary treatment and worse, fraudulent claims by the new “suppliers” in the market place.

Or was it just manipulation?

An NHS watchdog has severely reprimanded a private company providing out of hours GP services in Cornwall which was short of staff, provided inadequate training, left patients facing long waits and manipulated its results.

Serco, which had a turnover of £4.6 billion in 2011 and is poised to win new contracts from the NHS under the changes introduced by the Health and Social Care Bill, made some doctors work double 13 hour shifts overnight and other staff work 11 hour daytime shifts.

Inspectors made unannounced visits to the company’s call centre in Truro and five clinics during April and May.  They found Serco was in breach of four of the eight essential standards, including failing to protect vulnerable adults and children from abuse.

Inspectors found the company had been manipulating its daily performance reports by altering incorrect entries which showed the service was failing to hit its targets. But it did not carry out similar checks on the accuracy of entries showing it had hit its targets – and inspectors found two examples of failed calls which had been wrongly classified as achieved.

BBC 20 May 2008
A dentist and his wife who stole more than £30,000 from the NHS by claiming money for treatment never given to patients have been jailed.
Newton Johnson, 52, and his wife Judith, 51, also claimed for treatment for "phantom" patients, which included the name of a family pet dog.

UK Dental Fraud: 2007200820102012

I have highlighted the problems in the US before. 

Fraud is seen as more profitable than drug dealing.

NHS: Changes Or A Conspiracy Against The Public Interest

The Cockroach Catcher on Amazon Kindle UKAmazon Kindle US

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