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CMA investigations on the rise

Posted by: Laurence Simons 16/02/16

An investigation in the British Medical Journal (BMJ) has revealed that the doctors’ regulator, the General Medical Council (GMC), missed a warning by an insurance company in 2012 that incentives were being offered to doctors for referring patients to certain hospitals. The problem was, as the report details, ‘widespread, particularly in London, and significant in value’. This led to patients being ‘diverted to units in which doctors have financial interests’ with some payments exceeding $100,000.

The Competition and Markets authority (CMA) conducted a two year investigation into the private health sector which unearthed several major companies – including BMI Healthcare, Spire and the American giant HCA – that had paid consultants for referrals. Other incentives documented ranged from direct payments to the provision of facilities, or shares in “equity participation schemes”. The CMA concluded that the problem was indeed ‘widespread’ and placed a ban on such ‘cash for referrals’ schemes in private healthcare which will come into force in April.

In a joint comment for the BMJ alongside the journal’s deputy editor Dr Kamran Abbasi and clinical fellow Kate Adlington, Dr Godlee commented: “The current GMC guidance asks that doctors declare their financial interests to their patients and in their medical notes when appropriate, but it leaves the onus on doctors to decide what and where, creating a grey area that is open to exploitation. Perhaps the only viable way of achieving such transparency is by a public register of payments and other benefits given to doctors.”

A senior doctor who worked for the insurance company that originally informed the GMC of malpractice told the BMJ: “It’s a sad day for the medical profession when a competition regulator has had to issue an order…because our own regulator has failed to do so.”

The CMA has had a huge amount of work in recent years from a variety of different – and highly lucrative – sectors. This is having a knock-on effect, with top legal and compliance talent being snapped up to work on these cases. A combination of a wide selection of industries and no evidence of work subsiding any time soon is good news for professionals, with many considering moves into this field. All in all, it looks as though 2016 will be another interesting year for the CMA.