Patient Fraud

CASE STUDY

Dr X contacted MDS to get advice in relation to breaching patient confidentiality when suspicions arose that a patient was fraudulently obtaining a Blue Badge by feigning or exacerbating a disability.

Dr X was the consultant in charge when an Emergency Nurse Practitioner (ENP) raised concerns that they had seen a patient who was due to renew their blue badge permit but who they did not consider to have a disability. Concerns were also raised that the patient was undertaking large amounts of manual labour and walking long distances which was inconsistent with their application for a Blue Badge.

MDS ADVICE & OUTCOME

MDS reviewed Dr X’s situation and advised that it was not in Dr X’s skill set or Dr X’s colleagues skill set to determine disability for the purposes of the Department of Work and Pensions. 

As such, Dr X was informed that this may not reach the threshold for breach of patient confidentiality as they had no direct contact with the patient. However, MDS felt that the alleged offence could constitute a serious crime.

MDS further advised against disclosing any of the patient notes and if such a request was received to refer it to the department manager to get advice from the Trust legal team.

Dr X alerted the Council to the potential fraud that was suspected. MDS advised that they should follow this disclosure up by making it clear that they were passing information on and that the Clinician involved would be able to provide further information upon request.

LEARNING POINTS

Under the GMC Good Medical Practice breaching patient confidentiality can be justified if the benefits to an individual or society outweigh both the public and the patient’s interest in keeping the information confidential. Disclosure may be justified to protect individuals or society from risks of serious harm such as serious crime. 

If a doctor is unsure whether their potential disclosure is appropriately justified they should seek advice from their Caldicott or data guardian or medical defence organisation before making the disclosure and wait until they have received the advice before acting.

Doctors should also be conscious of where matters fall outside of their skill set and where they were not directly involved in the patient’s care and consider whether it is appropriate for them to get involved.