The NHS Providing Services to "Health Tourists" under False Pretenses
Posted Jan 29 2013 12:00am
I have posted a number of previous notes about medical tourism . However, a recent article brought to my attention the concept of fraudulent medical tourism provided by the National Health Services (NHS) in the U.K. (see: Overseas 'health tourists' costing NHS at least £40m ). By fraudulent, I mean that individuals from abroad not entitled to health services from this government health service are receiving them. Read the excerpt from the article below for more details.
The NHS has lost at least £40m in four years by failing to identify so-called "health tourists" accessing hospital care, a BBC investigation has found. Health Minister Anna Soubry admitted the system for identifying people who are not entitled to free care is complex and at times "flawed". Hospitals in England and Wales are obliged to ensure NHS patients have lived in the UK for the past 12 months. But 45 out of 133 hospital trusts which gave details said they do not check....[T]hose hospitals that had identified overseas visitors who had received treatment on the NHS had written off more than £40m in losses. That is a figure that one MP described as "the tip of the iceberg" of overall costs of treating visitors who should not be given free access to the health care system. A six-month long investigation by the BBC also uncovered a thriving black market in medical referrals and treatment in which access to GPs and hospital care was being fraudulently bought and sold. In Birmingham, a practice manager was secretly filmed selling places at a doctor's surgery for as much as £800 per patient. An undercover reporter, posing as a health tourist, paid £800 to register at the practice and was then able to obtain an MRI scan for free at a local hospital....In two other instances, after middlemen were paid to arrange GP access, London-area hospitals performed both X-rays and blood tests for other undercover reporters using fake identities....The grey area hinges on the term "ordinarily resident" which is the threshold by which people are entitled to free NHS care." Ordinarily resident is a phrase which sounds good common sense, but when it comes down to actually implementing it the policy is often unworkable,"....Pamela Ward, a retired NHS overseas manager, said in many cases hospitals assume that patients referred by NHS GP surgeries qualify for free care. "They have an English address, a registered GP, an NHS number - so there is really no way that the hospital will pick up from that," she said of the lack of checks
No big surprise here. The NHS provides free care to those of its citizens who are "ordinarily" resident in the country. This care is high caliber, certainly when compared to the care offered in many countries in East and South Asia. Some individuals will thus seek medical care illegally in the U.K. I get the sense that there are two facets to this problem. The first is that the NHS is ponderous and bureaucratic and has trouble sorting out the U.K citizens who are entitled to free care from the others. It doesn't help much that some of the eligibility rules are complex and ambiguous. The second problem is that the there is a thriving black market for medical referrals and treatment within the U.K. This is fueled by "under the table" payments to health care workers in the system. For bribes, its possible for someone to be "registered" in a medical practice and then be deemed eligible for CT scans. I am sure that there are comparable problems in the U.S. for Medicare services.