Scotland's NHS Thieves BBC Scotland Investigates

Scotland's health service is under unprecedented strain.

Yet it's also losing hundreds of millions of pounds every year.

Lost not through waste, but because of fraud.

It's an enormous amount of money diverted from patient care.

Tonight, we investigate

the fraudsters who are bleeding cash from our NHS.

I think it was clear that he was taking steps to do what

he could in order to avoid a prosecution.

For the first time, we film with the NHS Fraud Police

and reveal how much damage is being done

to the health service by criminals.

If you commit a fraud against the NHS then appropriate

action will be taken against you.

We show you who they are...

I'm ashamed, as a dentist,

that any dentist could behave in this manner.

..and how they do it.

Good morning, folks.

Thanks for sharing your time this morning.

As you know, this morning's meeting is about Operation Brass...

It's just after 11 on a Thursday morning

and the NHS Fraud Police are being briefed.

..approximately £30,000...

Fraser Paterson is the investigation manager

with NHS Scotland's Counter Fraud Services, or CFS.

They're not police officers,

but they do have special investigative powers.

They're responsible for pursuing doctors, dentists, nurses,

patients - anyone who steals from the £11 billion NHS budget.

..surveillance footage that we took.

As you know, we looked at that from...

'I believe the work that we do is vitally important

'to the people of Scotland.'

Every man, woman and child in Scotland

requires the health service,

they will use the health service at some stage in their life.

Therefore, it's vital that the resources set aside for the

health service are available for those people at their time of need.

ARCHIVE: On July 5th, the new National Health Service starts,

providing hospital and specialist services,

medicines, drugs and appliances,

care of the teeth and eyes, maternity services...

Throughout its lifetime,

money and resources in the NHS have been under pressure.

ARCHIVE: The hospitals -

the largest and most costly branch of the National Health Service.

The hospitals have the equipment and the staff,

but no amount of re-equipping or brightening up

can overcome the national shortage of beds.

There's no doubt that the NHS is under strain.

And any money which is taken out of the health service makes it

even more stretched.

So when you hear that fraud is costing the NHS

hundreds of millions of pounds a year, you realise how tackling

fraud is pivotal to tackling the problems of the NHS.

No cameras have been allowed to film with CFS before.

But tonight, they open their files to the BBC.

Often, a case starts with a tip-off.

Investigators received a call.

A medical supplier had spotted its products for sale on eBay.

Products it had already sold to a hospital in Glasgow.

They could see that those items had been sold previously to the

Health Board by numbers that appeared on the actual items themselves.

It was the job of Fraser Paterson and his team

to find out how these surgical stitches, or sutures,

used in operations, had made their way out of the NHS and onto eBay.

Two online accounts seemed to be being used

to sell the medical goods.

We were able to check the payroll records

at Greater Glasgow and Clyde Health Board

and realised that two of the people involved with those accounts

were employees of the board.

The email address on one of the accounts belonged to this man,

Douglas Stevenson. He was an anaesthetic assistant,

working in operating theatres with special access to medical supplies.

Investigators could also see where he'd been working - one of the

hospitals was The Royal Hospital for Sick Children in Glasgow.

By this point, investigators were getting a picture of the extent

of medical equipment being stolen from the NHS and being sold on eBay.

Well, they were selling, for example, specialist medical and surgical

equipment, so, so we're talking sutures, we're talking scalpels

that were used for operations, we're talking about specialist

surgical equipment, drill bits, items that were used for implants.

So quite a broad brush.

They were being bought all over the world.

But CFS had to get proof it was Douglas Stevenson who was

stealing and re-selling them.

An early morning raid was carried out on Stevenson's home,

and another address.

What we found from his address was what appeared to be

the resale of these products in motion,

if you like, caught in motion,

because we found a computer system which had some of the products

that subsequently we identified had been stolen

sitting beside the computer, in effect, ready to be sold.

And we had a notebook which appeared to be an order book,

and envelopes with details of the next customer on there.

So there was an order literally being packaged and ready to go?

That's the way it appeared, yes.

Investigators found more than 100 items from the hospital

hidden in Douglas Stevenson's house and garage.

Another 115 stolen items were recovered from the second address.

OK, Douglas, what I'm showing you now is a notepad that we have

recovered from your property...

CFS interviewed Douglas Stevenson under caution.

He was arriving at work with a rucksack, filling it up

from the store room and walking straight out the front door -

right past security.

Nobody suspected a thing.

I've found here one of Douglas Stevenson's eBay accounts,

Stevenson136.

I can see 188 people have left him feedback

and they're saying, "brilliant eBayer, excellent service".

Just the sheer volume of stuff here, it reads like a hospital inventory.

Sutures or stitches, surgical tape, dressings - he's prolific.

At court, Douglas Stevenson admitted responsibility

and pled guilty to defrauding the NHS out of £23,000.

But CFS say they believe the real figure was at least

three times that amount.

Over 850 items had been stolen and sold on eBay,

and this amounted to some 75,000 or so pounds, give or take.

And that's quite a conservative estimate.

Stevenson's crime meant he was making a tidy profit for himself -

tax free, and at the tax-payers' expense.

Here, we're talking about the sick kids' hospital in Glasgow,

that they are the ones who are the victims here,

and therefore the patients are the victims here.

-Yes.

-How does that make you feel?

I certainly think he's a healthcare professional who has

abused his position of trust, and there are items that were

intended for patient care that didn't go there.

And the NHS has not been able to re-use those items.

Although we recovered them, they have no value to the NHS.

They could not be re-used or put back into the supply chain.

So that money has gone.

The Stevenson case shows how easy it is to take

money away from frontline care.

Eventually he was caught,

but for two years it looked like he was getting away with it.

He was sentenced to 20 months in prison, and struck off,

but not a penny of the £75,000 worth of supplies that CFS say

he stole has ever been paid back.

NHS lawyers are now trying to recover the money from his pension.

We asked to speak to Douglas Stevenson about his crime.

Through his lawyer, he told us he didn't want to comment.

To know the extent of theft and fraud in the NHS,

we asked for details from all the health boards in Scotland

under freedom of information laws.

The figures show that, over the last five years,

identified fraud has increased by 42%.

In Scotland's biggest health board, where Douglas Stevenson worked,

Greater Glasgow, the value rocketed from £148,000 to £341,000.

And that's only the amount they detected and recorded.

From the very inception of the NHS,

the first point of contact has been the family doctor.

It's a relationship at the very core of the health service,

and one based on trust.

-Hello. Good morning.

-Good morning.

-Do come and sit down. I've not seen you before.

-No.

I've just come into the district.

My husband has a new job at the school here and I wonder

-if you'd take us on your list, please?

-Certainly.

There are three partners here, but you can always see me

personally if you want to, it's just as well to make sure when I'm

going to be here, and you can of course telephone for an appointment.

One doctor who abused that position of trust was

the GP Susan McKinnon.

We received a call from the health board, and they had had

concerns reported to them by a pharmacist in the Greenock area.

That pharmacist was Eddie McAnerney.

Dr McKinnon had come into the chemist to pick up

a prescription for a patient.

Dr McKinnon presented with a prescription at this

pharmacy in November 2011.

The pharmacy technician Louise Smith was also working.

She brought in a prescription initially,

a handwritten prescription, already signed on the back.

I dispensed the prescription, obviously I checked it,

one of my members of staff had dispensed it,

I'd checked it, given it out.

But something made Louise think again.

I just thought it was strange that a GP had come into a pharmacy

to collect the prescription.

-How unusual is that?

-Very.

You don't normally see a GP collecting a prescription.

The other aspect which had raised alarm bells for the staff

was what the prescription was for -

diazepam and the opiate dihydrocodeine,

both controlled drugs and one a known substitute for heroin.

When she'd left the building, Louise turns round and asked me,

"Why is a GP picking a prescription up?"

I had said to him that she was a GP in the Mount Pleasant Practice,

and he said to photocopy the prescription front and back.

Despite their suspicions,

they felt they didn't have enough evidence.

But a few weeks later, Susan McKinnon's luck ran out.

She'd gone into a different chemist in a different town.

But it too was owned by Eddie McAnerney.

I was reading the prescription through

and I'd actually bagged it up and tagged it, and I thought,

"Wait a minute, that's diazepam and dihydrocodeine. Who's signed it?"

Dr McKinnon. For a patient's name that, you know,

was obviously different to hers,

so she'd been using someone else's name.

Dr McKinnon was waiting to collect the prescription.

But on the form she had claimed she was the patient.

Hi there. Is this your prescription?

And I said, "Oh, you've signed the back of the prescription",

she'd signed the patient's name that was on the prescription,

not her own.

Can you give me your date of birth, please?

I said, "So, if that's you, what's your date of birth?"

And she panicked.

And she said, she started getting quite...

..nervous.

Obviously, this is a big mistake.

-Is this prescription for you?

-Of course.

-Are you this person?

-Yes.

At this moment in time, I thought that she was being forced to obtain

these drugs by deception by a third party,

and I was really concerned about her safety.

I didn't know at this time that she was taking them herself.

It's my prescription and...

I was in shock, I think, didn't know what to do, phoned the health board.

Counter Fraud launched Operation Lynx.

At this point, they had no idea what they were dealing with.

When we did some background work,

our statistician looked at her prescribing history, and what

became clear was that, just for those particular drugs that she had been

provided with on those two suspicious dates,

that there was a large number of prescriptions prescribed by her

of the same or a very similar nature.

Investigators uncovered hundreds of occasions where diazepam

and opiates had been prescribed by Dr McKinnon,

costing the NHS thousands.

But they suspect there were even more.

What made us even more concerned was the fact in relation to over

a hundred of those prescriptions, the name McKinnon appeared

as the patient's representative on the back of those prescriptions,

and that equated to some 10,000 or so tablets over the period,

so that in itself is a sizeable figure.

Dr McKinnon gave nothing away in her interview with officers.

She managed to conceal what she was doing for four years.

And here's how she did it.

Using her surgery computer,

Susan McKinnon would create the prescription in her patient's name,

print it, so she had a copy to take to the chemist,

and then, pretending she had the "wrong patient",

she'd simply delete it.

When IT specialists checked her computer,

they found she'd created and deleted prescriptions

over and over again, using not only her own log-in,

but some of her colleagues', too.

For her patients,

McKinnon's fraud could have had serious consequences.

If another doctor thought they were taking the drugs, it could

have led to the patient being given the wrong treatment or diagnosis.

They may even have been allergic to them.

'I'm on my way to see Alisa Scott, whose name was used eight times.'

Here we've got 56 tablets, 28 tablets...

..another 28, another 56.

This is how many times it's been done in your name.

-Is that your signature?

-No. No. Definitely not.

I'm upset that she's used disadvantages

and horrible times in my life to her advantage.

So you obviously did trust her?

Oh, aye. I trusted her more than anybody.

Another patient agreed to speak to us, but anonymously.

She was concerned it would affect her job as a school teacher.

Dr McKinnon had prescribed her diazepam and opiates

for apparently complaining of "muscle spasm".

I really don't understand how she,

or why, she chose to go into my records

and falsify a condition

that she then wrote these prescriptions for.

I don't really understand the thought process behind that.

Susan McKinnon was a GP, and therefore would be

seen as a cornerstone of the community, in that local community.

She has damaged that relationship with her patients, and damaged

the standing of her profession, I would say, in doing what she's done.

I actually find that I'm a wee bit more reluctant to go to the GP now.

I still feel quite betrayed.

I don't think I can fully trust them again.

If you can't trust your doctor, you can't trust anybody.

In June last year, Dr McKinnon was convicted of fraud.

She was also suspended as a GP,

but has recently been reinstated under strict supervision

and can no longer prescribe certain drugs.

Dr McKinnon gave no comment to this programme.

Dr McKinnon's fraud directly affected her patients

and their trust in doctors.

But everyone can be affected when money goes missing from the NHS.

So exactly how much money

never reaches the patients it's meant to help?

According to our FOI responses, health boards say they've

detected a total of £2 million worth of fraud in the last five years.

But Counter Fraud Services estimate that a staggering £110 million -

or 1% of Scotland's entire NHS budget -

is lost to fraud every year.

That's a huge sum of money. But is that the full picture?

'I went to meet Jim Gee,

'the former director of CFS for the Department of Health in London.

'He is now one of the leading authorities on healthcare fraud

'in the world.'

The estimate for the amount of fraud in the NHS in Scotland

is about 1%. Is that realistic?

We currently have 15 years of data covering 14 different

types of healthcare expenditure.

We're currently finding just under 7% on average of that expenditure

is lost to fraud.

7% of the whole of the NHS budget in Scotland?

Well, if Scotland is in line with the rest of the world,

that's what I would expect to see.

If Jim Gee is right, as much as £800 million could be being

stolen from the NHS in Scotland every year.

But, remember, the NHS's estimate

puts fraud levels at just £110 million a year.

Now that would mean that Scotland is the best in the world

at deterring fraud.

Are we the best in the world?

I think we are certainly there or thereabouts, we are

very successful at what we do.

The health service in Scotland is very well run.

As I've said, frauds are committed by a small minority.

It's a hidden crime, it's a difficult crime to quantify.

There have been a number of studies and Mr Gee has put

fraud between 3 and 8% in any public sector organisation.

There's nothing to indicate that the health service would be

any different from that.

But we don't believe we want to quote massive figures

when we can't fully justify them.

But the losses are certainly a considerable amount of money.

You're looking at somewhere

between 300 million and 800 million going astray.

If we could save that amount of money, what impact

would it have on patients?

I mean that's brand-new hospitals every year,

that's enormous amounts of doctors, nurses, operations...

It is, it's an enormous amount of money diverted from patient care.

People not getting the treatment they need,

sometimes having to wait longer for that treatment,

and that's why it's an important problem which needs to be tackled

very seriously with an appropriate level of investment in that work.

What we're really focusing on is deterrence.

We're trying to make every effort to ensure that the money doesn't

go out the front door in the first place,

Rather than trying to recover it after we've lost it,

what we're focusing on is deterrence,

so that people don't actually commit the fraud in the first place.

And that's a far more cost effective way,

and it protects the health service.

It's no use having lost the money then trying to get it back.

What we're really saying is that

we're not going to lose it in the first place.

My experience of the NHS Counter Fraud service in Scotland is

that they're very effective but I don't think they have the

resources they need to have the impact they would like to have.

And that also appears to be reflected in the amount

of cash health boards manage to recover from fraudsters.

Almost 90% of the money recorded as fraud by them is never recouped.

And what happens to those who commit fraud against the NHS?

In the last five years only 33 people - or 5% of those

reported for fraud - were ever convicted.

In this final case, it's not just the crime that's important.

It appears to show how the true scale of NHS fraud is far

greater than is ever revealed.

'Somehow, when you know exactly what the dentist is doing,

'it doesn't seem so frightening.

'It may look like a waste of time and money,

'but the dentists hope these children won't grow up like their parents,

'whose dental bill to the state is about £20 million a year.'

It begins in Auchinleck, East Ayrshire,

where Stuart Craig ran his dental practice.

He became one of the highest earners in the country,

but he still found time to raise money for charity.

A random check on his highly profitable dental practice

revealed that Mr Craig had a secret,

and showed exactly why his business was so lucrative.

There's certainly no evidence of these teeth needing to be

filled in between them, so these are big fillings that he was doing.

And of course the bigger the filling, the bigger the fee.

John Cameron is the NHS' senior dental advisor in Scotland.

It's his job to catch dentists who aren't up to scratch or

fiddling the books.

Stuart Craig's earnings caught his eye.

We do look at what dentists do and see

if they're an outlier compared to their colleagues,

and he certainly was an outlier for gold crowns.

I picked at random 40, 41 cases.

We got the laboratory bills in, we checked that he had actually

claimed for precious metal, and the laboratory bills

showed in 100% of them that he had provided non-precious metal.

Every single case?

Every single one of the ones I selected.

Now, that's obviously very unusual because

if somebody might make an error and tick the wrong box, but this

was a case that every single one of this particular type of crown.

-So it's as easy as cross that box...

-Mmm-hmm.

..on this sheet, the precious one - the gold one - on that sheet,

and bingo!

So these are pretty much like a blank cheque?

Yes. No, you could say that.

John Cameron alerted CFS, which started its own investigation.

They also found an intriguing pattern of charging

the NHS for gold or "precious" crowns

when in fact he was putting cheaper crowns in his patients' mouths.

The scam was netting Stuart Craig a small fortune.

What we did was looked back to over a period from 2008 to 2012

and that highlighted to us

over 200 claims that had been made where the same suspicion existed.

Could this have been an administrative mistake?

On a once-or-twice situation, perhaps that might be the case,

but on this scenario, there was a really high percentage of

what appeared to be mis-claiming - really high irregularity rate.

Stuart Craig was also interviewed under caution by CFS officers.

On the brink of being struck off,

he made one final attempt to avoid justice.

He sent a text to former staff asking them

to take some of the blame.

But the standard of Stuart Craig's work on patients was also

causing concern.

So this person's teeth have had...?

-Were being damaged...

-Were being damaged?!

..by the dentist carrying out work that wasn't necessary.

And then you have an onward spiral doing more and more treatment,

to the deterioration of the patient.

Poor fillings led to root treatments the patient may never have needed.

Bad root treatments led to crowns. Failed crowns would

have to be repeated - all making Stuart Craig more money.

I'm ashamed, as a dentist,

that any dentist could behave in this manner.

In November 2012,

Stuart Craig was struck off by the General Dental Council.

In an extraordinary ruling it said he had,

"Put his own financial interests first",

that, "a large number of treatments were "harmful to his patients",

and that he had a "deep-seated attitudinal problem."

Last summer,

Stuart Craig was convicted of fraud against the NHS

of just under £2,000.

He was given a fine.

Is that the true scale of his fraud?

Well, no. I did an investigation,

having received the General Dental Council's findings.

I went through and looked at the scale of mis-claims,

and I estimate that the amount that he is due to repay -

which is possibly an underestimate -

is £782,896.60p.

You're kidding!

So, Stuart Craig appears to have stolen

three-quarters of a million pounds,

but the NHS says he hasn't paid back a penny

and he seems to have disappeared.

In January 2012, the NHS sent Stuart Craig a breakdown

of the three-quarters of a million pounds they say he owes them.

Stuart Craig owned a number of properties,

including his dental surgery.

We've discovered that his home address

and his dentistry business are no longer in his name.

According to land registry documents and Companies House documents,

they were transferred into his girlfriend's name within

weeks of receiving the NHS' letter.

Correspondence we sent to Stuart Craig's home

asking for an interview was returned.

But one letter reached him

through the dentist now working at his former practice.

Stuart Craig hasn't replied.

The NHS say their mail is now being returned.

They've even hired private detectives to try to find him.

So the hunt for Mr Craig continues.

The NHS is a lifesaver but it needs every penny it can get.

The Stuart Craig case

and the others we've highlighted reveal the hidden scale of fraud

against our health service - that money could employ 37,000 nurses.

So the consequence of stealing from the NHS,

is poorer care for all of us when we're sick -

just when we need it most.