THE FAMILY HEALTH SERVICES APPEAL AUTHORITY
MRS C LE BOSQUET
DECISIONS AND REASONS
This is an
application by Bromley PCT for a National Disqualification pursuant to Section
49 of the Health and Social Care Act 2001.
DECISION AND REASONS
- The Appeal was heard by Mrs J R Crisp (Chairman);
Mr R Stokes (Professional); and Mrs L Jacobs (Lay).
- Prior to the hearing all 3 panel members confirmed
they had no prior involvement or knowledge of the case. This fact was
communicated to the parties at the outset of the hearing.
- The Appellant was represented by Mr J Reynolds. The
Respondent was represented by Miss Kapila. Mrs Le Bosquet was not present at the hearing. A doctor’s
note was submitted in evidence confirming she was unwell. The panel heard oral evidence from Mr
Golingay on behalf of Bromley PCT and from Mr Ben Lewis and Mrs Arlette
Bibijean on behalf or Mrs LeBosquet.
The panel also considered the written evidence contained in the two
- Mrs LeBosquet joined the Ophthalmic list for
Bromley HA (as was) in 1992.
- Following an audit irregular claims were found to
have been submitted by Mrs LeBosquet.
- In 1997 Civil Proceedings in the High Court were
commenced by Bromley PCT against
Mrs LeBosquet for the return of monies overpaid. Those proceedings commenced on the 12th
November 1997 when a Tomlin Order was made providing:-
admission of liability Mrs C LeBosquet shall pay to the PCT within seven days
the sum of £100,000
(ii) Mrs C
LeBosquet would not pursue the PCT for any unpaid fees
(iii) Mrs C LeBosquet
withdrew from Bromley PCT’s list with immediate effect
- In 2001 Mrs
C LeBosquet applied to join the Bromley PCT list. She was included on the
list for Bexley and Greenwich. As
such it was an automatic application for Bromley.
- On the 2nd and 3rd October
2002 the GOC had a disciplinary hearing charging Mrs LeBosquet with
serious professional misconduct under Section 17(1)(b) of the Opticians
Act 1989. The basis of the charge
1 (a) Between
1994 and June 1997 you submitted or caused to be submitted, “NHS spectacle
voucher application” forms on behalf of those patients set out in Appendix A
each of the forms was a claim for a payment of a supplement as the patient had
“ been supplied” with frames with a datum centre of distance 56”or less
of the patients required frames with a datum centre of distance 56mm or less
The frames with datum centre of distance 56mm or less were not
in fact supplied
(e) The claims for such
2 (a) Between
November 1994 and April 1997 you submitted or caused to be submitted “NHS
spectacle voucher application” forms on behalf of those patients set out in Appendix
each of the forms was a claim for the payment of a supplement for a tint.
(c) Spectacles for a
tint were not in fact supplied
(d) The claims for such
a payment were:
3 (a) Between
March 1995 and June 1997 you submitted or caused to be submitted “NHS spectacle
voucher application” forms on behalf of patients set out in Appendix C
each of the forms was a claim for the payment of two pairs of spectacles
(c) Only one pair of
spectacles was in fact supplies to each of the patients
(d) The claims for such
a payment were:-
In relation to the patients
names in Appendix D you failed to keep adequate patients records.
- On the 8th November 2002 the GOC
reconvened. Mrs C LeBosquet was
found guilty in relation to head (1)(e)(i)(ii). 1(a)-(d) inclusive having been admitted during the course of
the hearing. The GOC were satisfied that the relevant claims were
unwarranted and that Mrs C LeBosquet knew and acted deliberately and
dishonestly in making those claims.
- Heads two and three were dismissed.
- On head four the GOC found that the record keeping
was inadequate and failed significantly below the standard expected by the
professional and the public.
- As a result of those findings Mrs C LeBosquet was
suspended for 6 months and the penalty order of £1600 was made.
- In July 2003 Bromley PCT recommended removal and
convened an oral hearing which took place on the 12th September
- By letter of the 17th September 2003 Mrs
C LeBosquet was advised that she would be removed from the list of Bromley
- Mrs C LeBosquet wrote to the FHSAA to appeal
against that decision on the 6th October 2003.
- On the 11th December 2003 Mrs C
LeBosquet withdrew the appeal stating the decision not to proceed was for
personal reasons only and should not be construed as acceptance of Bromley
- Mrs C LeBosquet was removed from Bromley PCT’s list
on the 19th December 2003.
- On the 16th March 2004 Bromley PCT made
application to the FHSAA for a National Disqualification.
19. Mr Golingay gave
evidence for Bromley PCT. He is the
Associate director for Clinical Governance.
He provided a written statement in addition to his oral evidence.
- He confirmed that following the findings of the GOC
a panel was convened to consider what action it might take. The PCT accepted the decision of the
GOC, such decision having been made to the requisite criminal standard of
proof i.e. beyond reasonable doubt that Mrs C LeBosquet has made
deliberate and unwarranted claims.
- This was a significant fraud over a period of 3
years. The GOC had found her to be dishonest.
- The PCT considered both the DOH guidance and also
government guidance on countering fraud in the NHS. It was not felt appropriate by the PCT
to consider monitoring Mrs C LeBosquet. The PCT felt that there would be
considerable costs further that the relationship had entirely broken down
between the PCT and Mrs C LeBosquet due to her breach of trust.
- Mr Golingay confirmed that it gave him cause for
concern that Mrs C LeBosquet has never accepted the findings of the
GOC. She accepted that she had
made unwarranted claims stating that it was a mistake.
- He said that he felt it was entirely appropriate
for an application to be made for National disqualification as this was
not a local issue, it was large fraud carried out over a period of time
i.e. 3 years.
- Julian Thornington was not present. He had supplied 2 statements. He is a local counter fraud specialist
contracted to work for Bromley PCT.
He had been working in that capacity since April 2002.
- Mr Thornington stated that the value of unwarranted
optical fees for the small
frame supplements came to some £84,692.30 of NHS funds,
and in addition Mrs C LeBosquet agreed to waive claim to a further £15,000 in
respect of claims for GOS services submitted for period August to September
1997. In terms of size of fraud in the
NHS this was of considerable value.
- As Local counter fraud specialist he supported the
conference decision for removal from the list.
- Ben Lewis gave evidence on behalf of Mrs C
LeBosquet. He is a senior
Optometric advisor in South Wales.
He is responsible for the monitoring of claims within the Health
Service in South Wales. He has
provided advice to the Health Service in Wales and has been an expert
witness in a number of cases.
- He confirmed that monitoring was done by the
Counter fraud service as it was part of their job. He said if someone had fallen foul and
was reinstated the Counter Fraud Service would undertake to do the monitoring. In his experience they had never had
someone carry out a second fraud, he stated it would be rather stupid of
them to do it again. He said
monitoring of claims was ongoing and virtually impossible to get around.
- On cross-examination it became apparent that Mr
Lewis had not seen or considered the GOC’s findings against Mrs LeBosquet.
- He was not aware of the facts of this particular
case. He confirmed it would be a last resort to remove someone from the
- He confirmed that if a person were found guilty of
defrauding the NHS by the criminal standard of proof i.e. beyond all
reasonable doubt, monitoring would not be successful. If this scenario occurred he maintained
that the chances of getting back onto a list would be virtually nil.
- Arlette Bibijean is the manager of Excel Nursing
home. She confirmed that she knew
Mrs C LeBosquet. She stated that she was a very caring person who provided
services to the home. If there
were any problems she would refer to the hospital or write to the patients
- Mr Reynolds on behalf of the PCT submitted that
given the size, nature and contexts in which this fraud was carried out
especially with elderly and confused patients it was entirely appropriate
that Mrs LeBosquet should be removed and made the subject of a National
- There would be a loss of confidence by the public
in the NHS if she were allowed to continue to practice.
- There is a fundamental difference between
deliberate fraud and unintentional fraud. This had been a deliberate fraud
acted out on a systematic basis over a number of years.
- Mrs Kapila submitted removal was the last resort.
Although two charges were proved two were not proved and there was no
finding against her on clinical competence.
- She had worked since 1997 with no irregularity and
to remove her now was disproportionate and oppressive.
- She had paid her dues to society as she had been
suspended for 6 months and repaid
the monies to Bromley PCT.
- Monitoring could be put in place. There was a counter fraud service in
place which would do it. The PCT
had a duty to consider the effect that National disqualification would
have and to consider what support frameworks were available in line with
- Finally there were a number of references in
respect of character and work. She
would be providing good services and therefore the application should be
- The panel accept that Mrs C LeBosquet worked from
1997 to 2002. In respect of
Bromley PCT however this period only covers 2001 to 2002.
- There has been a finding against Mrs C LeBosquet by
the GOC to the criminal standard of deliberate and unwarranted claims
- There was no appeal against those findings by Mrs C
- The appeal against the original removal was
withdrawn. It is not accepted by
the panel that Mrs C LeBosquet could not pursue an appeal against either
body. The only evidence which has been provided confirms from her GP that
she has been suffering from severe stress since 1998. She is not suffering
from depression or any other clinical or psychological illness which would
prevent her from maintaining an appeal.
- The panel finds that Mrs C LeBosquet has not
accepted the findings of the GOC which is evident in her application for
the appeal against the original removal which was subsequently
withdrawn. The panel believe due
to this that Mrs C LeBosquet would be unable to rebuild a relationship with Bromley PCT or
maintain a relationship with any other PCT.
- The panel find that this is a significant fraud
perpetrated over 3 years for nearly £85,000 together with a further
£15,000 in fees unclaimed.
Although the last fraud was committed in 1997 the findings of the
GOC were only made in November 2002.
- The panel do not accept that Mrs C LeBosquet could
be monitored successfully and adopt Mr Lewis’s evidence.
- The panel accepts that there is no evidence of any
irregularity since 1997, however Mr Golingay gave evidence that no claims
had been submitted to his knowledge to Bromley PCT during this
period. The only other evidence
which the panel has is not tested.
- The panel accept the references and accept that Mrs
C LeBosquet is probably good and understanding with patients. Further she provides a good service to
- The panel has considered:-
Section 49(N) of the Health and Social Care Act 2001.
Department of Health Authority guidance delivering
quality in primary care
National disqualification guidance together with Annex
F dealing with fraud within that document.
NHS (General Ophthalmic) regulations 1986 as amended at
Article Six of the European Convention
52. The panel consider
it to be so significant a breach of trust that National Disqualification is not
disproportionate further it is not considered that the public would consider it
- The panel therefore find that the application on
behalf of Bromley PCT is appropriate.
- Accordingly the panel grant Bromley PCT’s
application for a National Disqualification.
55. Finally, in
accordance with Rule 42(5) the Family Health Services Appeal Authority
(Procedure) Rules 2001, we hereby notify the Appellant that she may have rights
relating to appeal under Section 11 of the Tribunal and Enquiries Act 1992.
…………………………… Judith R Crisp
(Chairman) with the approval of
Mr R Stokes
Mrs L Jacobs