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How should we deal with fit note fraud?

The Department of Work and Pensions (DWP) has contacted us to say a patient is suspected of changing the number of weeks specified on a Med 3 form issued by one of our GPs. How should we respond?

Dr Rob Hampton

Dr Rob Hampton: Encourage the patient to deal directly with the DWP

It’s worth remembering that the only statutory purpose of the fit note is to help a patient get sick pay. In all other regards, it serves only as advice to the patient. However, the reality is the Med 3 has become a de facto standard that carries much weight in the employment and welfare sector.
GPs have been able to generate e-fit notes since October 2014, but I estimate only 30-40% of the profession is doing this. And whether computer generated or not, fit notes are susceptible to modification. When dealing with this, first consider patient confidentiality. Act in an objective manner that includes the patient in the dialogue and places responsibility on them to address the issue directly with the DWP, first checking that there has been no misinterpretation by the department.
Write to the patient, with a copy to the DWP, outlining the reported discrepancy. Tell them you have a clear record of the note and re-issue a ‘copy’ to them. Try to arrange a telephone consultation with the patient to discuss the matter and tell them that you are seeking advice about direct disclosure to the DWP from your medical defence body.
A patient forging documents constitutes a clear breach of trust between patient and the practice, but rather than remove them from the list, appoint a member of staff to discuss the issue with the patient once the immediate concern has been clarified.

Dr Rob Hampton is a GP in Wigston and clinical director of the Leicestershire Fit For Work service

 

Dr Helen Cotton - online

Dr Helen Cotton: Try to gain patient consent before proceeding

The GMC views confidentiality as ‘important but not absolute’ and accepts it can be breached in three situations: if information is required by law; if the patient has consented to disclosure; and if disclosure is in the public interest.1 Therefore, if possible, try to gain consent from the patient before discussing the issue with the DWP.
Removing the patient is more complex. GMC guidance states this should be an exceptional action taken as a last resort when the doctor-patient relationship has broken down irretrievably.2

This course of action could become appropriate if the practice had issued a warning to the patient in the 12 months preceding the current discrepancy.
It will also be necessary, then, to review the existing relationship with the patient. Consider whether this is typical behaviour or something out of character that could be discussed with them. Even if the doctor concerned feels unable to continue providing care, the patient could start seeing another GP.
If the practice has an existing policy about removing patients this should be followed. As removal is an exceptional event, have a practice discussion before the decision is made.

Dr Helen Cotton is a GP in Yeovil

 

Dr Rachel Birch - online

Dr Rachel Birch: Get a copy of the fit note

Remember that you have a duty of confidentiality to your patient; don’t provide any clinical details about the patient or even confirm whether they attended that day.
However, you should ask the DWP to provide you with a copy of the fit note. Either confirm that this is a copy of the original or state that the note, in its current form, was not issued by the practice.

If the latter is the case, contact the patient to explain you are aware of alterations to a fit note issued to them and that you are obliged to confirm this with the DWP.1 Explore why the patient felt the need to take this action as there may be mental health or social issues that you are unaware of.
The GMC states ‘you should end a professional relationship with a patient only when the breakdown of trust between you and the patient means you cannot provide good clinical care to the patient’.2 If you are considering removing the patient from your practice list, you should first provide them with a warning, outlining the reasons for doing so.
You do not have grounds for immediate removal, unless the patient has previously been warned for similar behaviour.

Dr Rachel Birch is a medicolegal consultant at the Medical Protection Society

 

When contacted by Pulse, the DWP said that it investigates all allegations of fraudulent claims to benefits, which can include instances where Med 3 forms have been altered, but could not offer more specific advice on the case.

 

References

1 General Medical Council. Good Medical Practice (2013).

2 General Medical Council. Ending your professional relationship with a patient (2013).

 

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Readers' comments (10)

  • Very informative thank you , we have literally just started going through this scenario, where pt's have been found to have altered their fit notes. can i also ask what advice people can give as regards to pt's altering the fit notes, but us being informed by their employer re this not the dwp.

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  • Patients get away with whatever they like... Can't remove them without warning for fraud!! . Bloody joke

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  • If it is for the DWP (and not an employer) then consent for the DWP to contact and obtain information from the GP is not required. By claiming benefits the person has agreed to that - or so the DWP tell us on IB113s (or whatever they are now called).
    One of the advantages of an 'electronic' Med 3 is that you know exactly what you put on it. Although (annoyingly) they cannot be reprinted easily, they can be viewed as a secure pdf file and reprinted via printscreen option in conjunction with other software.
    I would not hesitate to send or fax a copy of what I know was definitely on the Med 3 direct to the DWP and let them decide if it was altered and what to do about it if that were indeed the case.

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  • let the stasi government sort it, gps have enough to without wiping more of the brown stuff of the governments backside

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  • Does this really happen? More to the point, how should a patient deal with a GP who falsifies information on their medical record - aside from the leave the practise?

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  • Recently we had enquiry from an employer for one of the employee ( not our patient) who used our letterhead to issue a private certificate. I was asked if I had issued the same, which on checking records, we had not.
    I had to confirm to employer that employee in question was not on our list of patients and that certificate was forged and not issued by our practice. Employee would most likely to be disciplined or sacked .Do we have a case against employee who used our name for a fraudulent act?

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  • can you imagine what would happen to a GP discovered to have committed fraud? - and would their confidentiallity be respected in the daily mail??

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  • \\\fraud ..police case..what is this fuss all about..

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  • Exactly this situation happened with me, patient had altered from 2 to 12 weeks and DWP called to query but weren't atall interested in investigating, said they had bigger fish to fry... Police said it wasn't their remit either... Med defence ditto...

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  • ... (annoyingly) they cannot be reprinted easily....
    an 'electronic' Med 3 can easily reprinted as it is stored on the computer file as fit note attachment
    We are now EMIS WEB but even in LV we could do that. In LV it used was scrolled across "DUPLICATE"
    just
    - open the document
    -print it
    your receptionist can open and print it as well
    I hope this helps

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