1492582841015 - ACC not reviewing procedures after doctor suspended for making false claims

ACC not reviewing procedures after doctor suspended for making false claims

ACC says it will not be tightening invoicing measures after a Christchurch doctor used confidential medical information to falsely claim thousands of dollars in compensation.

The current system, based on trust, is deemed sufficient, the agency says. The Christchurch case, which included payments totalling over $30,000, was ruled a one off.

Dr Preechapon Tovaranonte was suspended after he copied patient information from a Christchurch Hospital database onto a USB stick while employed as a medical registrar.

He used the stolen information to bill false ACC claims for sports injuries he said he treated in a “mobile clinic” from his home, despite never meeting the patients.

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ACC spokeswoman Stephanie Melville said there were a “number of systems in place to identify unusual or aberrant invoicing behaviours”.

Once a claim was accepted by ACC, the provider was able to submit an invoice using their claim number, she said. The number was also used to track payments and to monitor performance.

Tovaranonte filed claims for 253 services to patients over 14 months. The Canterbury District Health Board (CDHB) had no record of Tovaranonte’s involvement in 40 per cent of the consultations, including some dating back to 2010.

It was the latest in a string of false claims and misused resources during his employment with the CDHB.

Tovaranonte’s false claims totalled $30,888.99. In 2013, he returned $21,771.13 and the remaining $9117.86 was deemed “inappropriate billing” and declined for payment by ACC. Tovaranonte said the error was based on ignorance, not criminal intent.

In a letter to the CDHB, he claimed to have exaggerated the number of patients to “make [himself] appear more professional”.

Melville said the matter, which was revealed in a Health Practitioners Disciplinary Tribunal document released on Tuesday, had not been referred to police.

“It’s an historical issue . . . once identified the doctor repaid the money immediately.”

She said district health boards were provided bulk funding, which meant ACC was not directly invoiced.

Tovaranonte’s claims were red-flagged when he invoiced for procedures that happened at the same time clients were seen at the DHB, appearing as though he was “double dipping” into funds.

“ACC would not expect this to happen and an investigation was undertaken when this billing behaviour was noted.”

The tribunal found Tovaranonte’s conduct “fell well short of the standards of conduct expected of competent, ethical and responsible practitioners”.

Tovaranonte was suspended for three months, fined $5000 and ordered to pay $50,000 in costs. When he returned to work he would have to be supervised and work in approved practices.

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