Norwich Union Healthcare Limited ("NUHC"), part of Aviva, today announced that it is cracking down on the industry issue of healthcare provider fraud by implementing a new comprehensive counter-fraud programme.
- Specialist programme will measure cost of healthcare provider fraud
- KPMG appointed to support the programme
Norwich Union Healthcare Limited ("NUHC"), part of Aviva, today announced that it is cracking down on the industry issue of healthcare provider fraud by implementing a new comprehensive counter-fraud programme.
Norwich Union Healthcare will work with top advisory firm KPMG and use proven techniques, applied extensively in the NHS and internationally, to be able to accurately measure the total cost of healthcare provider* fraud. Counter fraud work undertaken in the NHS resulted in a reduction in losses of up to 60% and more than £800m in financial benefits (a 12:1 return on the costs of the work).
Simon Arnold, director of healthcare - customer, said: "Our customers come first and we are determined that resources intended to provide the best possible healthcare to our policy holders should not be lost to fraud and error by a minority of healthcare providers. While the vast honest majority would condemn their actions, it is sadly this minority whose actions result in raised premiums for our customers and divert resources from their intended purposes. Working with KPMG, and their counter fraud specialists, we will reduce these losses for the benefit of our policy holders."
Hugh Laing, NUHC chief medical officer, said: "The vast majority of healthcare professionals will welcome this new comprehensive approach. Fairness and objectivity will be our watchwords and I am confident that we can help protect NUHC and its resources to the benefit of all its stakeholders."
Jim Gee, director of fraud services at KPMG Forensic, and formerly CEO of the NHS counter fraud service, said: "We are looking forward to working with NUHC with the aim of reducing their losses to healthcare provider fraud and error. I am confident that there are real gains to be made for NUHC and its policy holders from implementing this programme. Healthcare provider fraud is not a victimless crime, it raises costs for policy holders and diverts resources from delivering healthcare. Alongside the joint initiative with NUHC we are delighted to sponsor the inaugural Health Insurers Counter Fraud Group (HICFG) Conference next month."
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Media contacts:
Lucy Grubb - Norwich Union press office
07800 691935 / lucy.grubb@norwich-union.co.uk
Notes to editors:
* Healthcare providers include GPs, Specialists, Consultants, Healthcare Professionals and Hospitals.
Examples of healthcare provider fraud
- Upcoding - where a provider charges for a more complex procedure than that which was actually performed.
- Unbundling - where the procedure is broken down into its constituent parts and billed individually, resulting in higher remuneration.
- Other examples include: charges for procedures that have not been performed; over treatment; and, in some cases, clinical mismanagement.
About the programme
NUHC's new approach will involve measurement of losses to provide accurate information about the nature and extent of the problem. With a proper understanding of the problem, the right solution can then be applied to reduce these losses. NUHC will be implementing a comprehensive range of action:
- to develop a real anti-fraud culture and mobilise the honest majority
- to create a strong deterrent effect and minimise the dishonest minority
- to prevent fraud where it is not deterred (including the simplification and clarification of procedures)
- to detect fraud where it is not prevented (including using advanced rules and model based data analytics)
- to investigate suspicions of fraud in a fair and objective manner
- where fraud is believed to be present to seek to apply a range of criminal, civil, disciplinary and regulatory sanctions
- to recover losses so that the resources can be reapplied to patient care.
NUHC pays out several hundred million pounds per year, every year, on the treatment of claims made on its private medical insurance policies.
Simon Arnold - biography
Simon Arnold is the director of customer for Norwich Union Healthcare. Simon is accountable for the service delivered to over 1 million customers and has made significant improvements to the customer journey since joining in 2007. Simon is responsible for ensuring Aviva's core value of "protecting what is important to our customers" is a reality for Norwich Union Healthcare's customers every day. Simon was previously head of customer experience for Norwich Union Life before moving to Healthcare.
Hugh Laing - biography
Hugh Laing is the chief medical officer for Norwich Union Healthcare. Hugh is highly respected in the Industry as a result of his vast experience and qualifications. Hugh has provided expert advice to the Norwich Union Healthcare claims and underwriting teams for the past 10 years, as well as continuing to work as a senior partner in general practice and consulting at the Nuffield Hospital Hampshire. Since 2006, Hugh has sat on the General Medical Council's (GMC) Fitness to Practice Panel demonstrating his support of the GMC in protecting the public and the public interest by ensuring the highest standards are maintained in the practice of medicine.
About KPMG Forensic
KPMG's Forensic practice includes a European fraud investigation and dispute advisory team of over 400 people, including ex-police officers, forensic accountants, expert witnesses, data mining consultants and fraud risk management specialists. It investigates and advises on all suspicions of fraud and deception including, for example, procurement, treasury, payments and revenue fraud and accounts manipulation, as well as giving expert evidence in commercial disputes. Our casebook ranges from matters of less than £50,000 to major international scams or disputes with sums at risk in excess of $1 billion. Our clients are truly international. Over the last few years we have worked all over the UK and Europe. Other countries in which we have carried out assignments include Brazil, Argentina, Congo, UAE, India, Libya, Iraq, Indonesia, and South Korea.
About KPMG: KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and operates from 22 offices across the UK with nearly 11,000 partners and staff. The UK firm recorded a turnover of £1.6 billion in the year ended September 2007. KPMG is a global network of professional firms providing Audit, Tax, and Advisory services. We operate in 148 countries and have more than 113,000 professionals working in member firms around the world. The independent member firms of the KPMG network are affiliated with KPMG International, a Swiss cooperative. KPMG International provides no client services.
About Norwich Union Healthcare
Norwich Union Healthcare was founded in 1990 as the healthcare arm of Norwich Union, part of Aviva, and now provides a range of private medical insurance, income protection, occupational health and group life products and services that cover over 2,400,000 lives. It is one of the largest providers of income protection and private medical insurance in the UK.
Norwich Union Occupational Health, a sister company of Norwich Union Healthcare, provides occupational health solutions and services to a wide range of industry sectors. By utilising their large fleet of purpose built mobile clinics and approved medical centres, staffed by a team of experienced occupational physicians and nursing staff, the services are designed to meet the individual needs of clients.
Norwich Union Healthcare is authorised and regulated by the Financial Services Authority and is a member of the Association of British Insurers and the Financial Ombudsman Service.
About Health Insurers Counter Fraud Group UK (HICFG)
HICFG is an industry initiative to prevent and detect fraud within healthcare and the insurance industry. The HICFG membership consists of 11 health insurance companies. The inaugural annual conference takes place on 20 - 21 November in Newcastle and details can be found on the website http://www.hicfg.co.uk