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Peter Ellis web site - Christchurch crèche case |
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What is
the total number of investigations of claimant fraud for each financial year
starting 1 July 2000, including the present financial year to date, broken
down by regions and claimant categories such as working while receiving
weekly compensation without advising ACC, misrepresenting an accident or
injury, misrepresenting their capacity in order to gain entitlements, making
false declarations, altering documents to obtain entitlements or other types
of fraud?
I refer
the Member to the attached table. The table outlines the number of claimant
fraud investigations that have been referred to contracted private
investigators, for each financial year since 1 July 2001, broken down by ACC
branch management regions. These figures related to all types of claimant
fraud as ACC is unable to provide statistics of specific fraud categories. Number of
Claimant fraud investigations referred to Private Investigators since 1 July
2001, broken down by region
What is
the total number charges laid for claimant fraud for each financial year
starting 1 July 2000, including the present financial year to date, broken
down by regions and claimant categories such as working while receiving
weekly compensation without advising ACC, misrepresenting an accident or
injury, misrepresenting their capacity in order to gain entitlements, making
false declarations, altering documents to obtain entitlements or other types
of fraud?
ACC does
not collect the specific information that you have requested in a manner that
would allow an accurate answer to your question. The actual charges laid may
vary from case to case. For example, ACC may have a $500 fraud with 10
charges laid in the District Court as opposed to a $500,000 fraud charge with
only two charges laid. ACC is
able to provide the total number of prosecution files referred to the Crown
Solicitor for prosecutions, broken down by region, since 2001. I refer the
member to the attached table, which provides this information. Number of
Prosecutions referred to the Crown Solicitor, broken down by region, since
2001
What is
the total number of charges laid for provider fraud for each financial year
starting 1 July 2000, including the present financial year to date, broken
down by regions and any fraud categories used by ACC such as claiming for
treatments and services not provided, claiming times in excess of the time
spent with the claimant, over-servicing for financial gain, forged billing
schedules and documents, making false statements, claiming for patients that
don’t exist or other types of frauds?
For the
year 2005, the provider fraud team has referred three prosecution files to
the Crown Solicitors for prosecution. ACC is
unable to provide data for the number of charges laid for provider fraud
prior to 2005 as comprehensive statistics on provider fraud have only been
maintained in this year.
What is
the total number successful convictions for claimant fraud for each financial
year starting 1 July 2000, including the present financial year to date,
broken down by regions and claimant categories such as working while
receiving weekly compensation without advising ACC, misrepresenting an
accident or injury, misrepresenting their capacity in order to gain
entitlements, making false declarations, altering documents to obtain
entitlements or other types of fraud?
I refer
the Member to the attached table. The table provides a breakdown of the total
number of actual successful prosecutions for claimant fraud by regions, since
July 2000. Total
number of successful prosecutions for claimant fraud by region* since July
2000
*ACC branch management region
What is
the total number successful convictions for provider fraud for each financial
year starting 1 July 2000, including the present financial year to date,
broken down by regions and any fraud categories used by ACC such as claiming
for treatments and services not provided, claiming times in excess of the
time spent with the claimant, over-servicing for financial gain, forged
billing schedules and documents, making false statements, claiming for patients
that don’t exist or other types of frauds?
In the
current financial year, ACC has successfully convicted two providers. Both of
these providers were in the Auckland region. ACC is
unable to provide data for the number of successful convictions for provider
fraud before 2005. Comprehensive statistics on provider fraud has only been
managed in this year. Therefore, ACC is unable to provide an accurate answer
to your question for the period prior to 2005.
What is
the total amount spent on private investigation companies broken down by
financial year since 1 July 2000, company and amount?
Commercial
sensitivity issues have been raised in this question. As such I am unable to
provide a full response to the Member’s question. The total
amount spent on private investigation companies for each financial period: ·2000-2001:
$1,064,935.99
What is
the total number of complaints to professional bodies laid by ACC for
provider fraud for each financial year starting 1 July 2000, including the
present financial year to date, broken down by regions.
In the
financial year July 2003–June 2004 two complaints were laid with professional
bodies and both of these complaints were for providers in the Auckland
region. Since July 2004 to present there have been a further two complaints
laid with professional bodies against providers and again, both these
providers were in the Auckland region.
How many
times has ACC removed billing privileges from providers because of fraud or
suspected fraud for each financial year starting 1 July 2000 including the
present financial year to date broken down by regions.
Since
July 2004 ACC has imposed billing ‘restrictions’ on two providers as a result
of fraud investigation findings. Both of these providers reside in the
Auckland region, where the fraud was committed, and resulted in prosecutions. There is
no specific legislative provision which allows ACC to fully remove billing
privileges from registered providers. If a provider has a current Annual
Practicing Certificate, they are (by law) able to claim from ACC for services
supplied to claimants. At present, the only time that ACC will completely
cease dealings with a provider who has committed fraud is when a professional
body withdraws a provider’s Annual Practising Certificate. Remedies
currently available to ACC when a provider is found to have committed fraud
include billing restrictions, debt recovery, imposition of penalties,
criminal prosecution, complaints to professional bodies. Prior to
July 2004 ACC did not collect data on provider fraud in a manner that allows
an accurate answer to your question. ACC has upgraded its electronic data
base since July 2004, which allows for data on provider fraud to be recorded.
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