The battle against fraud is one that the insurance sector is well accustomed to, but when a medical professional is struck off as a result it’s a reminder that the issue cannot be taken lightly.
That is what has happened to Mr Adeshina, the director of Physique Rehab Ltd. Having previously been given an 18-month suspension from the Healthcare Professions Tribunal Service (HCPTS), he has now been taken off the HCPC register on the back of an investigation by Mulsanne Insurance and insurance law firm Keoghs.
The investigation came about on the back of a personal injury claim from a 13-year-old after a single vehicle incident – it was referred to Keoghs by the insurer as concerns were raised over alleged treatment. Adeshina is said to have delivered 11 sessions of physiotherapy over the phone, also speaking to the claimant’s mother via a non-professional interpreter, and did not carry out a physical examination of the claimant. In fact, according to the law firm, he had the claimant’s mother carry out the treatment instead.
As a result, Keoghs delved into his history and discovered a previous suspension for possessing counterfeit currency and making off without payment. His suspension period from November 2015-March 2016, overlapped with two of the treatment sessions brought forward by the claimant.
A final hearing on the issue took place on April 30 with evidence put forward suggesting that a physiotherapist can lead telephone treatment for a maximum of two sessions, at the conclusion of which the need for physiotherapy should be established and resolved either without intervention or through face to face contact. It was ultimately deemed that the treatment was not clinically appropriate – with Paul Twilley, claims director at Mulsanne Insurance, describing it as “an excellent outcome.”
Healthcare-enabled fraud strategy lead for Keoghs, Matthew Ruck, meanwhile, noted that the result was a testament to hard work.
“We continue to recommend that insurers undertake full validation of any claims for rehabilitation that they receive in order to confirm exactly what treatment, if any, has actually been undertaken and to ensure that the documents received in support are accurate and honest,” he said. “In the absence of specific expert evidence there will always be difficulty establishing whether a particular mode of treatment is clinically appropriate in a given case, however this decision provides a useful guide and hopefully will serve as a warning to those healthcare professionals who may be tempted to submit or support exaggerated, misleading or entirely false treatment claims.”
