AC-2023-LON-002171 - [2024] EWHC 132 (Admin)

The conclusion of dishonesty in respect of charge 6(f) is the second finding that is challenged in this appeal. As the PCC noted, the claim was submitted for treatment undertaken between 3 – 31 March 2017 in respect of Patient 22, but that there was no record of any appointment for this patient during these dates. Dr Imani said that the claim was for fillings that were provided on 21 April 2017, that is to say after the date the claim was submitted. She admitted that she had not crossed the box on the FP17 to indicate that the treatment was “incomplete” and accepted that it was an inappropriate claim.

When it turned to consider whether dishonesty had been established, the PCC quoted the explanation that Dr Imani had provided in her witness statement as to her misunderstanding regarding the submission of FP17s at the end of the financial year:

“It was my understanding that if you started a course of treatment in one contract year then you couldn’t carry it forwards to the next year. I was reinforced in this view by a conversation I had with Jill Graham...in about 2014 in which she told me that I had to claim for the work before 31^st March in each contract year.

We would therefore fill in the Completion Date / Last Visit Date on the FP17 claim forms based on that understanding if we were unable to complete a patient’s course of treatment within the same contract year, we would submit a claim for incomplete treatment on the FP17 claim form.”

It is necessary to set out the PCC’s reasoning for rejecting this professed misunderstanding in some detail:

“However, the Committee did not accept your explanation as plausible for the following reasons:

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In oral evidence Ms Graham stated that she could not remember this conversation with you. However, she stated, ‘Although I cannot recall a conversation with Ms Imani, I would not have advised any NHS dental provider that a course of treatment that started in one financial year could not be carried forward (completed) in the next financial year, or that they should submit incomplete treatment submissions on the basis of the financial year.’ The Committee found Ms Graham’s evidence credible. It considered it highly unlikely that Ms Graham would have advised you it is correct to complete FP17 forms in the way you have. Jill Graham’s evidence was that she had not been able to find any correspondence from you raising any queries about the correct process for claiming;

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The Committee noted that you had held an NHS contract since 2006 and Jill Graham’s evidence was that the procedure on how to submit claims within financial years had not changed since then. You stated that you had realised in 2018 that it was wrong, but did not explain how you came to that conclusion.

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The Committee accepted the witness statement of Hayley Turner...

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Ms Turner relied on documents that had been saved to the NHSE casefile, which showed your UDA targets and performance from 2012 to 2018. The figures in these documents demonstrated that you have consistently underperformed on your Brighton contract for every year from 2012/13 to 2018/19. You agreed in your oral evidence that you knew that you were at risk of ‘clawback’ of NHS funds prepaid to you throughout these years.

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The Committee accepted Dr Scott’s evidence that, ‘By dating a claim that in fact relates to treatment completed in April or May, as if it had been completed during March, the Contractor ensures that the UDAs are accrued during the previous Contract Year’...The Committee also found credible Dr Scott’s expert evidence that there was no misunderstanding from the dental profession at large in relation to premature claiming.

In conclusion, after considering the evidence holistically and where the burden of proof lay, it determined that your explanation was implausible and inherently unbelievable. The Committee did not find it credible that you did not know that you were not entitled to claim in the financial year for work you had not yet completed. Because of this, unlike in relation to certain other allegations where the Committee has accepted that you may have been negligent and/or careless...it determined in relation to this particular allegation that it would have been your genuine belief at the time that you would not have been entitled to claim for Band 2 treatment that had not been completed in that financial year. The Committee then determined that this conduct would be viewed as dishonest by the objective standards of ordinary and decent people.”