Insurers need to take a close look at suspicious treatments to avoid the danger of ‘claims layering’, a leading defendant law firm has warned after it helped uncover bogus physiotherapy treatments.
The investigation by Keoghs, working with Mulsanne Insurance Company Limited, has led to an 18-month interim suspension for physiotherapist Adeyinka Adeshina by the Health and Care Professions Tribunal, which deals with fitness to practice issues.
The investigation arose from a claim by a 13-year-old passenger in a car crash for 11 sessions of physiotherapy, delivered by Mr Adeshina, the director of Physique Rehab Ltd, following his instruction by Concise Medico Ltd.
In what Keoghs described as “a bizarre twist”, the treatment was said to have been performed over the phone, with Mr Adeshina speaking to the claimant’s mother via an interpreter.
“Even more curiously, the discharge report bearing his signature stated that the treatment provided included ‘Massage release’, ‘Spinal posture correction’ and ‘ice/heat – ice pack followed by heat pack 10 mins’.”
Keoghs said the claimant’s mother had no knowledge of either the treatment or Mr Adeshina when interviewed by a claims inspector, but Mr Adeshina confirmed that he did undertake the alleged treatment when interviewed.
The firm said the claimant’s mother later contradicted herself in court by saying the treatment had, in fact, taken place.
Last November, Mr Adeshina went before the tribunal. Keoghs recorded: “At this point he started to backtrack, alleging that he delegated the treatment to another unidentified therapist and also alleging that the method of treatment was common practise.
“Neither of these assertions were accepted by the panel who gave the physiotherapist an 18-month suspension, stating that if Mr Adeshina ‘believes this to be acceptable treatment, he will put future patients at considerable risk… he also presents a significant risk to other members of the public and companies dealing with the registrant being charged for work he has not done’.”
The claim for the physiotherapy treatment was withdrawn.
Matthew Ruck, strategy lead for Keoghs’ healthcare-enabled fraud team, said: “There is no doubt that claims layering via medical professionals is a large problem when dealing with insurance fraud.
“Whether they are enabling or instigating, it is vital that the industry takes a close look at suspicious treatments and we are delighted that Mulsanne alerted us in this case, resulting in a satisfying decision at tribunal plus a withdrawn head of claim.”
Keoghs said it also discovered that Mr Adeshina had previously been suspended from the Health and Care Professions Council register following a conviction for possessing counterfeit currency and making off without payment; that suspension also overlapped with two of the treatment sessions in question.