Rehab fraud

Injured people will often trust their lawyers, medical experts and others involved in the claims process and rely upon them for guidance in pursuing their claims in a competent and appropriate manner, with their best interests in mind. Most will be deserving of that trust; others, unfortunately, will not.

As with anything in life, there will always be those who seek to profit from others’ misfortune. Financial reward can drive behaviour and greed creeps into a system otherwise supposed to assist genuinely injured people.

We are also seeing increasing, and with some experts almost universal, recommendations for rehabilitation treatment. Medical experts are the enablers whose referrals open up the way for medical treatment costs. Over several years, the industry has seen an increase in the number, cost and variety of claims for past and future rehabilitation treatment.

They have become an almost standard add-on to almost every claim; no matter the nature or severity of the injury. The cost per claim may seem small and may be dismissed or overlooked. But multiplied across all claims, the cost becomes significant and it can be a profitable business for medical agencies and those with financial interests in them; which often includes the solicitors running the claims.Often the focus is on profit; not the interests of the injured person.

Insurers should be aware of:

• Fabricated claims; sometimes with the assistance of healthcare professionals.
• Fabricated / misleading assessment and discharge reports, records and invoices
• Exaggerated treatment costs and claiming for treatments not undertaken
• Unqualified therapists
• Remote treatments being passed off as face to face treatments
• Generally poor quality and inappropriate treatments not carried out in accordance with care pathways and clinical guidelines.

The purpose of a personal injury claim is to put the injured person back, as near as possible, into the position they would have been in but for the accident. Monetary compensation is part of that process but an equally important part is medical opinion and rehabilitation to ensure that the injured person makes the best and quickest possible recovery.

Those involved in the claims process, on both sides, should be alive to poor conduct and outright fraud which is detrimental to both the integrity of the claims process as a whole and also to genuine claimants.

Medical experts and treatment providers should rightly be held to a high standard, even in low value ‘run of the mill’ claims and all claims should be subjected to an appropriate level of scrutiny to combat and eradicate such behaviours. Where healthcare professionals are implicated by way of poor practise or knowing involvement, Keoghs will assist its clients to pursue appropriate sanctions; whether civil, criminal or regulatory.

For more information,please contact Matthew Ruck