Keoghs Insight

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Healthcare Services - In Action

AWARE15/09/2015
Fraud Aware Issue 4

Keoghs acted on behalf of AXA PPP to secure a recovery of over £120,000 from a consultant plastic and reconstructive surgeon following an investigation into mis-billing.

The surgeon, Ciaran Healy, settled the claim without admission of liability in advance of proceedings being issued in the High Court.

Taking a robust approach, Keoghs pursued the recovery of mis-billed fees which AXA PPP had paid to Mr Healy for treatments he provided to their policyholders from private clinics including the Wellington Hospital in London.

A joint effort by AXA PPP and Keoghs established that Mr Healy had submitted invoices which were either not performed, were performed when it was not necessary to do so, were exaggerated or were misrepresented.

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.”

Simon Winnard, Director of Healthcare Fraud at Keoghs, commented: “Private Medical Insurers are increasingly using civil litigation in the fight against fraud. We are delighted that Keoghs’ unique combination of extensive technical PMI knowledge and market leading insurance fraud litigation expertise has helped our client secure another substantial settlement.”

Louise Cruise, Partner at Keoghs who worked on the case said: “This was a complex case which necessitated an understanding of our client's billing practices and medical procedures. By working together with our client we were able to identify and facilitate the recovery of a substantial amount of money which had been inappropriately invoiced to our client".