0:00:02 > 0:00:05Scotland's health service is under unprecedented strain.
0:00:05 > 0:00:09Yet it's also losing hundreds of millions of pounds every year.
0:00:09 > 0:00:12Lost not through waste, but because of fraud.
0:00:12 > 0:00:15It's an enormous amount of money diverted from patient care.
0:00:15 > 0:00:17Tonight, we investigate
0:00:17 > 0:00:20the fraudsters who are bleeding cash from our NHS.
0:00:20 > 0:00:24I think it was clear that he was taking steps to do what
0:00:24 > 0:00:27he could in order to avoid a prosecution.
0:00:27 > 0:00:31For the first time, we film with the NHS Fraud Police
0:00:31 > 0:00:33and reveal how much damage is being done
0:00:33 > 0:00:36to the health service by criminals.
0:00:36 > 0:00:39If you commit a fraud against the NHS then appropriate
0:00:39 > 0:00:40action will be taken against you.
0:00:40 > 0:00:42We show you who they are...
0:00:42 > 0:00:45I'm ashamed, as a dentist,
0:00:45 > 0:00:49that any dentist could behave in this manner.
0:00:49 > 0:00:52..and how they do it.
0:01:03 > 0:01:04Good morning, folks.
0:01:04 > 0:01:06Thanks for sharing your time this morning.
0:01:06 > 0:01:09As you know, this morning's meeting is about Operation Brass...
0:01:09 > 0:01:12It's just after 11 on a Thursday morning
0:01:12 > 0:01:15and the NHS Fraud Police are being briefed.
0:01:15 > 0:01:16..approximately £30,000...
0:01:16 > 0:01:20Fraser Paterson is the investigation manager
0:01:20 > 0:01:24with NHS Scotland's Counter Fraud Services, or CFS.
0:01:24 > 0:01:26They're not police officers,
0:01:26 > 0:01:28but they do have special investigative powers.
0:01:28 > 0:01:32They're responsible for pursuing doctors, dentists, nurses,
0:01:32 > 0:01:37patients - anyone who steals from the £11 billion NHS budget.
0:01:37 > 0:01:39..surveillance footage that we took.
0:01:39 > 0:01:41As you know, we looked at that from...
0:01:41 > 0:01:44'I believe the work that we do is vitally important
0:01:44 > 0:01:46'to the people of Scotland.'
0:01:46 > 0:01:48Every man, woman and child in Scotland
0:01:48 > 0:01:49requires the health service,
0:01:49 > 0:01:52they will use the health service at some stage in their life.
0:01:52 > 0:01:55Therefore, it's vital that the resources set aside for the
0:01:55 > 0:01:58health service are available for those people at their time of need.
0:02:00 > 0:02:03ARCHIVE: On July 5th, the new National Health Service starts,
0:02:03 > 0:02:05providing hospital and specialist services,
0:02:05 > 0:02:07medicines, drugs and appliances,
0:02:07 > 0:02:10care of the teeth and eyes, maternity services...
0:02:10 > 0:02:12Throughout its lifetime,
0:02:12 > 0:02:16money and resources in the NHS have been under pressure.
0:02:16 > 0:02:17ARCHIVE: The hospitals -
0:02:17 > 0:02:20the largest and most costly branch of the National Health Service.
0:02:20 > 0:02:24The hospitals have the equipment and the staff,
0:02:24 > 0:02:26but no amount of re-equipping or brightening up
0:02:26 > 0:02:29can overcome the national shortage of beds.
0:02:29 > 0:02:32There's no doubt that the NHS is under strain.
0:02:32 > 0:02:35And any money which is taken out of the health service makes it
0:02:35 > 0:02:37even more stretched.
0:02:37 > 0:02:40So when you hear that fraud is costing the NHS
0:02:40 > 0:02:45hundreds of millions of pounds a year, you realise how tackling
0:02:45 > 0:02:50fraud is pivotal to tackling the problems of the NHS.
0:02:50 > 0:02:54No cameras have been allowed to film with CFS before.
0:02:54 > 0:02:58But tonight, they open their files to the BBC.
0:03:02 > 0:03:05Often, a case starts with a tip-off.
0:03:05 > 0:03:08Investigators received a call.
0:03:08 > 0:03:12A medical supplier had spotted its products for sale on eBay.
0:03:12 > 0:03:16Products it had already sold to a hospital in Glasgow.
0:03:16 > 0:03:20They could see that those items had been sold previously to the
0:03:20 > 0:03:25Health Board by numbers that appeared on the actual items themselves.
0:03:25 > 0:03:28It was the job of Fraser Paterson and his team
0:03:28 > 0:03:31to find out how these surgical stitches, or sutures,
0:03:31 > 0:03:36used in operations, had made their way out of the NHS and onto eBay.
0:03:36 > 0:03:40Two online accounts seemed to be being used
0:03:40 > 0:03:41to sell the medical goods.
0:03:41 > 0:03:43We were able to check the payroll records
0:03:43 > 0:03:45at Greater Glasgow and Clyde Health Board
0:03:45 > 0:03:48and realised that two of the people involved with those accounts
0:03:48 > 0:03:49were employees of the board.
0:03:49 > 0:03:54The email address on one of the accounts belonged to this man,
0:03:54 > 0:03:56Douglas Stevenson. He was an anaesthetic assistant,
0:03:56 > 0:04:02working in operating theatres with special access to medical supplies.
0:04:02 > 0:04:07Investigators could also see where he'd been working - one of the
0:04:07 > 0:04:11hospitals was The Royal Hospital for Sick Children in Glasgow.
0:04:11 > 0:04:16By this point, investigators were getting a picture of the extent
0:04:16 > 0:04:22of medical equipment being stolen from the NHS and being sold on eBay.
0:04:22 > 0:04:25Well, they were selling, for example, specialist medical and surgical
0:04:25 > 0:04:32equipment, so, so we're talking sutures, we're talking scalpels
0:04:32 > 0:04:34that were used for operations, we're talking about specialist
0:04:34 > 0:04:39surgical equipment, drill bits, items that were used for implants.
0:04:39 > 0:04:41So quite a broad brush.
0:04:45 > 0:04:48They were being bought all over the world.
0:04:48 > 0:04:52But CFS had to get proof it was Douglas Stevenson who was
0:04:52 > 0:04:54stealing and re-selling them.
0:04:54 > 0:04:57An early morning raid was carried out on Stevenson's home,
0:04:57 > 0:04:59and another address.
0:04:59 > 0:05:02What we found from his address was what appeared to be
0:05:02 > 0:05:06the resale of these products in motion,
0:05:06 > 0:05:08if you like, caught in motion,
0:05:08 > 0:05:13because we found a computer system which had some of the products
0:05:13 > 0:05:16that subsequently we identified had been stolen
0:05:16 > 0:05:20sitting beside the computer, in effect, ready to be sold.
0:05:20 > 0:05:23And we had a notebook which appeared to be an order book,
0:05:23 > 0:05:28and envelopes with details of the next customer on there.
0:05:28 > 0:05:32So there was an order literally being packaged and ready to go?
0:05:32 > 0:05:34That's the way it appeared, yes.
0:05:34 > 0:05:38Investigators found more than 100 items from the hospital
0:05:38 > 0:05:42hidden in Douglas Stevenson's house and garage.
0:05:42 > 0:05:47Another 115 stolen items were recovered from the second address.
0:05:47 > 0:05:51OK, Douglas, what I'm showing you now is a notepad that we have
0:05:51 > 0:05:53recovered from your property...
0:05:53 > 0:05:56CFS interviewed Douglas Stevenson under caution.
0:06:22 > 0:06:26He was arriving at work with a rucksack, filling it up
0:06:26 > 0:06:30from the store room and walking straight out the front door -
0:06:30 > 0:06:32right past security.
0:06:33 > 0:06:34Nobody suspected a thing.
0:06:38 > 0:06:42I've found here one of Douglas Stevenson's eBay accounts,
0:06:42 > 0:06:44Stevenson136.
0:06:44 > 0:06:49I can see 188 people have left him feedback
0:06:49 > 0:06:54and they're saying, "brilliant eBayer, excellent service".
0:06:55 > 0:07:00Just the sheer volume of stuff here, it reads like a hospital inventory.
0:07:00 > 0:07:08Sutures or stitches, surgical tape, dressings - he's prolific.
0:07:10 > 0:07:13At court, Douglas Stevenson admitted responsibility
0:07:13 > 0:07:18and pled guilty to defrauding the NHS out of £23,000.
0:07:18 > 0:07:22But CFS say they believe the real figure was at least
0:07:22 > 0:07:24three times that amount.
0:07:24 > 0:07:29Over 850 items had been stolen and sold on eBay,
0:07:29 > 0:07:33and this amounted to some 75,000 or so pounds, give or take.
0:07:33 > 0:07:35And that's quite a conservative estimate.
0:07:35 > 0:07:40Stevenson's crime meant he was making a tidy profit for himself -
0:07:40 > 0:07:46tax free, and at the tax-payers' expense.
0:07:46 > 0:07:49Here, we're talking about the sick kids' hospital in Glasgow,
0:07:49 > 0:07:52that they are the ones who are the victims here,
0:07:52 > 0:07:55and therefore the patients are the victims here.
0:07:55 > 0:07:57- Yes.- How does that make you feel?
0:07:57 > 0:08:00I certainly think he's a healthcare professional who has
0:08:00 > 0:08:04abused his position of trust, and there are items that were
0:08:04 > 0:08:06intended for patient care that didn't go there.
0:08:06 > 0:08:09And the NHS has not been able to re-use those items.
0:08:09 > 0:08:12Although we recovered them, they have no value to the NHS.
0:08:12 > 0:08:15They could not be re-used or put back into the supply chain.
0:08:15 > 0:08:17So that money has gone.
0:08:17 > 0:08:21The Stevenson case shows how easy it is to take
0:08:21 > 0:08:23money away from frontline care.
0:08:23 > 0:08:26Eventually he was caught,
0:08:26 > 0:08:30but for two years it looked like he was getting away with it.
0:08:30 > 0:08:34He was sentenced to 20 months in prison, and struck off,
0:08:34 > 0:08:40but not a penny of the £75,000 worth of supplies that CFS say
0:08:40 > 0:08:43he stole has ever been paid back.
0:08:43 > 0:08:48NHS lawyers are now trying to recover the money from his pension.
0:08:50 > 0:08:53We asked to speak to Douglas Stevenson about his crime.
0:08:53 > 0:08:56Through his lawyer, he told us he didn't want to comment.
0:08:57 > 0:09:01To know the extent of theft and fraud in the NHS,
0:09:01 > 0:09:05we asked for details from all the health boards in Scotland
0:09:05 > 0:09:07under freedom of information laws.
0:09:07 > 0:09:10The figures show that, over the last five years,
0:09:10 > 0:09:14identified fraud has increased by 42%.
0:09:14 > 0:09:18In Scotland's biggest health board, where Douglas Stevenson worked,
0:09:18 > 0:09:26Greater Glasgow, the value rocketed from £148,000 to £341,000.
0:09:26 > 0:09:30And that's only the amount they detected and recorded.
0:09:30 > 0:09:33From the very inception of the NHS,
0:09:33 > 0:09:37the first point of contact has been the family doctor.
0:09:37 > 0:09:41It's a relationship at the very core of the health service,
0:09:41 > 0:09:43and one based on trust.
0:09:43 > 0:09:45- Hello. Good morning.- Good morning.
0:09:45 > 0:09:49- Do come and sit down. I've not seen you before.- No.
0:09:49 > 0:09:50I've just come into the district.
0:09:50 > 0:09:53My husband has a new job at the school here and I wonder
0:09:53 > 0:09:56- if you'd take us on your list, please?- Certainly.
0:09:56 > 0:09:59There are three partners here, but you can always see me
0:09:59 > 0:10:03personally if you want to, it's just as well to make sure when I'm
0:10:03 > 0:10:06going to be here, and you can of course telephone for an appointment.
0:10:06 > 0:10:10One doctor who abused that position of trust was
0:10:10 > 0:10:12the GP Susan McKinnon.
0:10:12 > 0:10:14We received a call from the health board, and they had had
0:10:14 > 0:10:17concerns reported to them by a pharmacist in the Greenock area.
0:10:17 > 0:10:21That pharmacist was Eddie McAnerney.
0:10:21 > 0:10:23Dr McKinnon had come into the chemist to pick up
0:10:23 > 0:10:25a prescription for a patient.
0:10:25 > 0:10:29Dr McKinnon presented with a prescription at this
0:10:29 > 0:10:33pharmacy in November 2011.
0:10:33 > 0:10:37The pharmacy technician Louise Smith was also working.
0:10:37 > 0:10:39She brought in a prescription initially,
0:10:39 > 0:10:43a handwritten prescription, already signed on the back.
0:10:43 > 0:10:46I dispensed the prescription, obviously I checked it,
0:10:46 > 0:10:48one of my members of staff had dispensed it,
0:10:48 > 0:10:50I'd checked it, given it out.
0:10:50 > 0:10:53But something made Louise think again.
0:10:53 > 0:10:56I just thought it was strange that a GP had come into a pharmacy
0:10:56 > 0:10:59to collect the prescription.
0:10:59 > 0:11:00- How unusual is that?- Very.
0:11:00 > 0:11:04You don't normally see a GP collecting a prescription.
0:11:04 > 0:11:08The other aspect which had raised alarm bells for the staff
0:11:08 > 0:11:10was what the prescription was for -
0:11:10 > 0:11:14diazepam and the opiate dihydrocodeine,
0:11:14 > 0:11:19both controlled drugs and one a known substitute for heroin.
0:11:19 > 0:11:23When she'd left the building, Louise turns round and asked me,
0:11:23 > 0:11:25"Why is a GP picking a prescription up?"
0:11:25 > 0:11:30I had said to him that she was a GP in the Mount Pleasant Practice,
0:11:30 > 0:11:34and he said to photocopy the prescription front and back.
0:11:34 > 0:11:36Despite their suspicions,
0:11:36 > 0:11:38they felt they didn't have enough evidence.
0:11:38 > 0:11:43But a few weeks later, Susan McKinnon's luck ran out.
0:11:43 > 0:11:47She'd gone into a different chemist in a different town.
0:11:47 > 0:11:50But it too was owned by Eddie McAnerney.
0:11:50 > 0:11:52I was reading the prescription through
0:11:52 > 0:11:55and I'd actually bagged it up and tagged it, and I thought,
0:11:55 > 0:11:59"Wait a minute, that's diazepam and dihydrocodeine. Who's signed it?"
0:11:59 > 0:12:03Dr McKinnon. For a patient's name that, you know,
0:12:03 > 0:12:05was obviously different to hers,
0:12:05 > 0:12:10so she'd been using someone else's name.
0:12:10 > 0:12:14Dr McKinnon was waiting to collect the prescription.
0:12:14 > 0:12:17But on the form she had claimed she was the patient.
0:12:17 > 0:12:19Hi there. Is this your prescription?
0:12:19 > 0:12:22And I said, "Oh, you've signed the back of the prescription",
0:12:22 > 0:12:25she'd signed the patient's name that was on the prescription,
0:12:25 > 0:12:26not her own.
0:12:26 > 0:12:28Can you give me your date of birth, please?
0:12:28 > 0:12:33I said, "So, if that's you, what's your date of birth?"
0:12:33 > 0:12:34And she panicked.
0:12:36 > 0:12:39And she said, she started getting quite...
0:12:41 > 0:12:43..nervous.
0:12:43 > 0:12:45Obviously, this is a big mistake.
0:12:45 > 0:12:49- Is this prescription for you? - Of course.- Are you this person?- Yes.
0:12:49 > 0:12:54At this moment in time, I thought that she was being forced to obtain
0:12:54 > 0:12:57these drugs by deception by a third party,
0:12:57 > 0:13:00and I was really concerned about her safety.
0:13:00 > 0:13:03I didn't know at this time that she was taking them herself.
0:13:03 > 0:13:06It's my prescription and...
0:13:06 > 0:13:13I was in shock, I think, didn't know what to do, phoned the health board.
0:13:14 > 0:13:17Counter Fraud launched Operation Lynx.
0:13:17 > 0:13:20At this point, they had no idea what they were dealing with.
0:13:20 > 0:13:22When we did some background work,
0:13:22 > 0:13:26our statistician looked at her prescribing history, and what
0:13:26 > 0:13:30became clear was that, just for those particular drugs that she had been
0:13:30 > 0:13:34provided with on those two suspicious dates,
0:13:34 > 0:13:39that there was a large number of prescriptions prescribed by her
0:13:39 > 0:13:42of the same or a very similar nature.
0:13:42 > 0:13:46Investigators uncovered hundreds of occasions where diazepam
0:13:46 > 0:13:49and opiates had been prescribed by Dr McKinnon,
0:13:49 > 0:13:51costing the NHS thousands.
0:13:51 > 0:13:54But they suspect there were even more.
0:13:54 > 0:13:57What made us even more concerned was the fact in relation to over
0:13:57 > 0:14:01a hundred of those prescriptions, the name McKinnon appeared
0:14:01 > 0:14:05as the patient's representative on the back of those prescriptions,
0:14:05 > 0:14:10and that equated to some 10,000 or so tablets over the period,
0:14:10 > 0:14:12so that in itself is a sizeable figure.
0:14:12 > 0:14:16Dr McKinnon gave nothing away in her interview with officers.
0:14:35 > 0:14:40She managed to conceal what she was doing for four years.
0:14:40 > 0:14:42And here's how she did it.
0:14:42 > 0:14:44Using her surgery computer,
0:14:44 > 0:14:48Susan McKinnon would create the prescription in her patient's name,
0:14:48 > 0:14:51print it, so she had a copy to take to the chemist,
0:14:51 > 0:14:55and then, pretending she had the "wrong patient",
0:14:55 > 0:14:58she'd simply delete it.
0:14:58 > 0:15:01When IT specialists checked her computer,
0:15:01 > 0:15:04they found she'd created and deleted prescriptions
0:15:04 > 0:15:07over and over again, using not only her own log-in,
0:15:07 > 0:15:09but some of her colleagues', too.
0:15:25 > 0:15:27For her patients,
0:15:27 > 0:15:30McKinnon's fraud could have had serious consequences.
0:15:30 > 0:15:33If another doctor thought they were taking the drugs, it could
0:15:33 > 0:15:38have led to the patient being given the wrong treatment or diagnosis.
0:15:38 > 0:15:40They may even have been allergic to them.
0:15:43 > 0:15:49'I'm on my way to see Alisa Scott, whose name was used eight times.'
0:15:49 > 0:15:54Here we've got 56 tablets, 28 tablets...
0:15:55 > 0:15:57..another 28, another 56.
0:15:59 > 0:16:02This is how many times it's been done in your name.
0:16:04 > 0:16:09- Is that your signature? - No. No. Definitely not.
0:16:09 > 0:16:12I'm upset that she's used disadvantages
0:16:12 > 0:16:15and horrible times in my life to her advantage.
0:16:16 > 0:16:18So you obviously did trust her?
0:16:18 > 0:16:21Oh, aye. I trusted her more than anybody.
0:16:25 > 0:16:29Another patient agreed to speak to us, but anonymously.
0:16:29 > 0:16:33She was concerned it would affect her job as a school teacher.
0:16:33 > 0:16:37Dr McKinnon had prescribed her diazepam and opiates
0:16:37 > 0:16:41for apparently complaining of "muscle spasm".
0:16:41 > 0:16:43I really don't understand how she,
0:16:43 > 0:16:45or why, she chose to go into my records
0:16:45 > 0:16:47and falsify a condition
0:16:47 > 0:16:51that she then wrote these prescriptions for.
0:16:51 > 0:16:55I don't really understand the thought process behind that.
0:16:55 > 0:16:59Susan McKinnon was a GP, and therefore would be
0:16:59 > 0:17:02seen as a cornerstone of the community, in that local community.
0:17:02 > 0:17:08She has damaged that relationship with her patients, and damaged
0:17:08 > 0:17:12the standing of her profession, I would say, in doing what she's done.
0:17:14 > 0:17:17I actually find that I'm a wee bit more reluctant to go to the GP now.
0:17:17 > 0:17:19I still feel quite betrayed.
0:17:19 > 0:17:21I don't think I can fully trust them again.
0:17:21 > 0:17:24If you can't trust your doctor, you can't trust anybody.
0:17:27 > 0:17:32In June last year, Dr McKinnon was convicted of fraud.
0:17:32 > 0:17:34She was also suspended as a GP,
0:17:34 > 0:17:38but has recently been reinstated under strict supervision
0:17:38 > 0:17:41and can no longer prescribe certain drugs.
0:17:41 > 0:17:43Dr McKinnon gave no comment to this programme.
0:17:45 > 0:17:48Dr McKinnon's fraud directly affected her patients
0:17:48 > 0:17:50and their trust in doctors.
0:17:50 > 0:17:55But everyone can be affected when money goes missing from the NHS.
0:17:55 > 0:17:57So exactly how much money
0:17:57 > 0:18:01never reaches the patients it's meant to help?
0:18:01 > 0:18:04According to our FOI responses, health boards say they've
0:18:04 > 0:18:10detected a total of £2 million worth of fraud in the last five years.
0:18:10 > 0:18:16But Counter Fraud Services estimate that a staggering £110 million -
0:18:16 > 0:18:20or 1% of Scotland's entire NHS budget -
0:18:20 > 0:18:22is lost to fraud every year.
0:18:24 > 0:18:28That's a huge sum of money. But is that the full picture?
0:18:28 > 0:18:30'I went to meet Jim Gee,
0:18:30 > 0:18:35'the former director of CFS for the Department of Health in London.
0:18:35 > 0:18:38'He is now one of the leading authorities on healthcare fraud
0:18:38 > 0:18:39'in the world.'
0:18:39 > 0:18:44The estimate for the amount of fraud in the NHS in Scotland
0:18:44 > 0:18:46is about 1%. Is that realistic?
0:18:46 > 0:18:50We currently have 15 years of data covering 14 different
0:18:50 > 0:18:51types of healthcare expenditure.
0:18:51 > 0:18:56We're currently finding just under 7% on average of that expenditure
0:18:56 > 0:18:57is lost to fraud.
0:18:57 > 0:19:017% of the whole of the NHS budget in Scotland?
0:19:01 > 0:19:04Well, if Scotland is in line with the rest of the world,
0:19:04 > 0:19:07that's what I would expect to see.
0:19:07 > 0:19:12If Jim Gee is right, as much as £800 million could be being
0:19:12 > 0:19:16stolen from the NHS in Scotland every year.
0:19:16 > 0:19:18But, remember, the NHS's estimate
0:19:18 > 0:19:23puts fraud levels at just £110 million a year.
0:19:23 > 0:19:26Now that would mean that Scotland is the best in the world
0:19:26 > 0:19:28at deterring fraud.
0:19:29 > 0:19:32Are we the best in the world?
0:19:32 > 0:19:34I think we are certainly there or thereabouts, we are
0:19:34 > 0:19:36very successful at what we do.
0:19:36 > 0:19:39The health service in Scotland is very well run.
0:19:39 > 0:19:43As I've said, frauds are committed by a small minority.
0:19:43 > 0:19:47It's a hidden crime, it's a difficult crime to quantify.
0:19:47 > 0:19:49There have been a number of studies and Mr Gee has put
0:19:49 > 0:19:53fraud between 3 and 8% in any public sector organisation.
0:19:53 > 0:19:56There's nothing to indicate that the health service would be
0:19:56 > 0:19:57any different from that.
0:19:57 > 0:20:01But we don't believe we want to quote massive figures
0:20:01 > 0:20:03when we can't fully justify them.
0:20:03 > 0:20:06But the losses are certainly a considerable amount of money.
0:20:06 > 0:20:07You're looking at somewhere
0:20:07 > 0:20:10between 300 million and 800 million going astray.
0:20:10 > 0:20:13If we could save that amount of money, what impact
0:20:13 > 0:20:14would it have on patients?
0:20:14 > 0:20:18I mean that's brand-new hospitals every year,
0:20:18 > 0:20:23that's enormous amounts of doctors, nurses, operations...
0:20:23 > 0:20:26It is, it's an enormous amount of money diverted from patient care.
0:20:26 > 0:20:28People not getting the treatment they need,
0:20:28 > 0:20:31sometimes having to wait longer for that treatment,
0:20:31 > 0:20:33and that's why it's an important problem which needs to be tackled
0:20:33 > 0:20:37very seriously with an appropriate level of investment in that work.
0:20:37 > 0:20:39What we're really focusing on is deterrence.
0:20:39 > 0:20:42We're trying to make every effort to ensure that the money doesn't
0:20:42 > 0:20:44go out the front door in the first place,
0:20:44 > 0:20:47Rather than trying to recover it after we've lost it,
0:20:47 > 0:20:49what we're focusing on is deterrence,
0:20:49 > 0:20:52so that people don't actually commit the fraud in the first place.
0:20:52 > 0:20:54And that's a far more cost effective way,
0:20:54 > 0:20:56and it protects the health service.
0:20:56 > 0:20:59It's no use having lost the money then trying to get it back.
0:20:59 > 0:21:01What we're really saying is that
0:21:01 > 0:21:03we're not going to lose it in the first place.
0:21:03 > 0:21:06My experience of the NHS Counter Fraud service in Scotland is
0:21:06 > 0:21:08that they're very effective but I don't think they have the
0:21:08 > 0:21:12resources they need to have the impact they would like to have.
0:21:12 > 0:21:14And that also appears to be reflected in the amount
0:21:14 > 0:21:18of cash health boards manage to recover from fraudsters.
0:21:18 > 0:21:23Almost 90% of the money recorded as fraud by them is never recouped.
0:21:23 > 0:21:27And what happens to those who commit fraud against the NHS?
0:21:27 > 0:21:31In the last five years only 33 people - or 5% of those
0:21:31 > 0:21:34reported for fraud - were ever convicted.
0:21:36 > 0:21:39In this final case, it's not just the crime that's important.
0:21:39 > 0:21:43It appears to show how the true scale of NHS fraud is far
0:21:43 > 0:21:45greater than is ever revealed.
0:21:46 > 0:21:50'Somehow, when you know exactly what the dentist is doing,
0:21:50 > 0:21:52'it doesn't seem so frightening.
0:21:52 > 0:21:55'It may look like a waste of time and money,
0:21:55 > 0:21:58'but the dentists hope these children won't grow up like their parents,
0:21:58 > 0:22:01'whose dental bill to the state is about £20 million a year.'
0:22:03 > 0:22:05It begins in Auchinleck, East Ayrshire,
0:22:05 > 0:22:09where Stuart Craig ran his dental practice.
0:22:09 > 0:22:12He became one of the highest earners in the country,
0:22:12 > 0:22:17but he still found time to raise money for charity.
0:22:17 > 0:22:21A random check on his highly profitable dental practice
0:22:21 > 0:22:23revealed that Mr Craig had a secret,
0:22:23 > 0:22:28and showed exactly why his business was so lucrative.
0:22:28 > 0:22:32There's certainly no evidence of these teeth needing to be
0:22:32 > 0:22:37filled in between them, so these are big fillings that he was doing.
0:22:37 > 0:22:40And of course the bigger the filling, the bigger the fee.
0:22:40 > 0:22:44John Cameron is the NHS' senior dental advisor in Scotland.
0:22:44 > 0:22:48It's his job to catch dentists who aren't up to scratch or
0:22:48 > 0:22:50fiddling the books.
0:22:50 > 0:22:53Stuart Craig's earnings caught his eye.
0:22:53 > 0:22:55We do look at what dentists do and see
0:22:55 > 0:22:58if they're an outlier compared to their colleagues,
0:22:58 > 0:23:01and he certainly was an outlier for gold crowns.
0:23:01 > 0:23:04I picked at random 40, 41 cases.
0:23:04 > 0:23:07We got the laboratory bills in, we checked that he had actually
0:23:07 > 0:23:10claimed for precious metal, and the laboratory bills
0:23:10 > 0:23:16showed in 100% of them that he had provided non-precious metal.
0:23:16 > 0:23:17Every single case?
0:23:17 > 0:23:19Every single one of the ones I selected.
0:23:19 > 0:23:21Now, that's obviously very unusual because
0:23:21 > 0:23:25if somebody might make an error and tick the wrong box, but this
0:23:25 > 0:23:30was a case that every single one of this particular type of crown.
0:23:30 > 0:23:33- So it's as easy as cross that box... - Mmm-hmm.
0:23:33 > 0:23:37..on this sheet, the precious one - the gold one - on that sheet,
0:23:37 > 0:23:39and bingo!
0:23:39 > 0:23:41So these are pretty much like a blank cheque?
0:23:41 > 0:23:43Yes. No, you could say that.
0:23:44 > 0:23:49John Cameron alerted CFS, which started its own investigation.
0:23:49 > 0:23:53They also found an intriguing pattern of charging
0:23:53 > 0:23:55the NHS for gold or "precious" crowns
0:23:55 > 0:23:59when in fact he was putting cheaper crowns in his patients' mouths.
0:24:00 > 0:24:04The scam was netting Stuart Craig a small fortune.
0:24:05 > 0:24:12What we did was looked back to over a period from 2008 to 2012
0:24:12 > 0:24:14and that highlighted to us
0:24:14 > 0:24:20over 200 claims that had been made where the same suspicion existed.
0:24:20 > 0:24:23Could this have been an administrative mistake?
0:24:25 > 0:24:29On a once-or-twice situation, perhaps that might be the case,
0:24:29 > 0:24:33but on this scenario, there was a really high percentage of
0:24:33 > 0:24:37what appeared to be mis-claiming - really high irregularity rate.
0:24:37 > 0:24:41Stuart Craig was also interviewed under caution by CFS officers.
0:25:00 > 0:25:02On the brink of being struck off,
0:25:02 > 0:25:06he made one final attempt to avoid justice.
0:25:06 > 0:25:09He sent a text to former staff asking them
0:25:09 > 0:25:10to take some of the blame.
0:25:27 > 0:25:30But the standard of Stuart Craig's work on patients was also
0:25:30 > 0:25:32causing concern.
0:25:32 > 0:25:34So this person's teeth have had...?
0:25:34 > 0:25:36- Were being damaged... - Were being damaged?!
0:25:36 > 0:25:39..by the dentist carrying out work that wasn't necessary.
0:25:39 > 0:25:44And then you have an onward spiral doing more and more treatment,
0:25:44 > 0:25:47to the deterioration of the patient.
0:25:47 > 0:25:52Poor fillings led to root treatments the patient may never have needed.
0:25:52 > 0:25:56Bad root treatments led to crowns. Failed crowns would
0:25:56 > 0:26:01have to be repeated - all making Stuart Craig more money.
0:26:01 > 0:26:03I'm ashamed, as a dentist,
0:26:03 > 0:26:08that any dentist could behave in this manner.
0:26:08 > 0:26:10In November 2012,
0:26:10 > 0:26:14Stuart Craig was struck off by the General Dental Council.
0:26:14 > 0:26:17In an extraordinary ruling it said he had,
0:26:17 > 0:26:20"Put his own financial interests first",
0:26:20 > 0:26:26that, "a large number of treatments were "harmful to his patients",
0:26:26 > 0:26:29and that he had a "deep-seated attitudinal problem."
0:26:29 > 0:26:31Last summer,
0:26:31 > 0:26:34Stuart Craig was convicted of fraud against the NHS
0:26:34 > 0:26:36of just under £2,000.
0:26:36 > 0:26:38He was given a fine.
0:26:38 > 0:26:41Is that the true scale of his fraud?
0:26:41 > 0:26:44Well, no. I did an investigation,
0:26:44 > 0:26:51having received the General Dental Council's findings.
0:26:51 > 0:26:56I went through and looked at the scale of mis-claims,
0:26:56 > 0:27:00and I estimate that the amount that he is due to repay -
0:27:00 > 0:27:02which is possibly an underestimate -
0:27:02 > 0:27:09is £782,896.60p.
0:27:09 > 0:27:10You're kidding!
0:27:10 > 0:27:12So, Stuart Craig appears to have stolen
0:27:12 > 0:27:15three-quarters of a million pounds,
0:27:15 > 0:27:17but the NHS says he hasn't paid back a penny
0:27:17 > 0:27:19and he seems to have disappeared.
0:27:21 > 0:27:27In January 2012, the NHS sent Stuart Craig a breakdown
0:27:27 > 0:27:32of the three-quarters of a million pounds they say he owes them.
0:27:32 > 0:27:35Stuart Craig owned a number of properties,
0:27:35 > 0:27:37including his dental surgery.
0:27:37 > 0:27:40We've discovered that his home address
0:27:40 > 0:27:44and his dentistry business are no longer in his name.
0:27:44 > 0:27:49According to land registry documents and Companies House documents,
0:27:49 > 0:27:53they were transferred into his girlfriend's name within
0:27:53 > 0:27:56weeks of receiving the NHS' letter.
0:27:56 > 0:27:59Correspondence we sent to Stuart Craig's home
0:27:59 > 0:28:02asking for an interview was returned.
0:28:02 > 0:28:03But one letter reached him
0:28:03 > 0:28:07through the dentist now working at his former practice.
0:28:07 > 0:28:10Stuart Craig hasn't replied.
0:28:10 > 0:28:13The NHS say their mail is now being returned.
0:28:13 > 0:28:17They've even hired private detectives to try to find him.
0:28:17 > 0:28:22So the hunt for Mr Craig continues.
0:28:22 > 0:28:26The NHS is a lifesaver but it needs every penny it can get.
0:28:26 > 0:28:27The Stuart Craig case
0:28:27 > 0:28:32and the others we've highlighted reveal the hidden scale of fraud
0:28:32 > 0:28:38against our health service - that money could employ 37,000 nurses.
0:28:38 > 0:28:40So the consequence of stealing from the NHS,
0:28:40 > 0:28:44is poorer care for all of us when we're sick -
0:28:44 > 0:28:46just when we need it most.