Doctors on benefits board did not check medical certificates’ authenticity, inquiry concludes

Doctors sitting on the board which decides whether applicants were qualified for disability benefits did not check the authenticity of certificates presented to them, an inquiry ordered by the government has revealed.

“Doctors always assumed that certificates were genuine and authentic. They argued that given the medical certificate was issued by a specialist or doctor who taught them at university or by a specialist or doctor they knew, there was no suspicion of any irregularity in these certificates,” the inquiry conclusions read.

After Labour MP Silvio Grixti was implicated in an extensive scheme spanning several years, involving the fraudulent acquisition of monthly disability benefits by hundreds of individuals who were not legitimately entitled to them, government had set up a three-person independent Board to assess the alleged abuse.

The Board enacted by Social Justice Minister Michael Falzon and Permanent Secretary Mark Musu’ was presided over by retired Judge Antonio Mizzi, Anthony Scicluna and Raymond Muscat

The inquiry also showed the doctors sitting on the board were never asked to declare any conflict of interest.

Inquiry recommendations

After it reviewed submissions made to it, the inquiry recommended that panels should have no less than three doctors, meaning the current pool of doctors should grow, so that board members are not chosen based on “availability”. Government has said it will carry out this recommendation.

The inquiry recommended that should the certificate issued by the specialist remain the only document on which the board bases its decision, stronger controls applied consistently to ensure the certificates’ authenticity should be put in place.

Government said the recommendation had already been addressed as of 2 October 2023, where after a number of internal discussions it was decided that instructions be issued to the secretaries of the medical boards to begin verification with the specialist who appears on every certificate submitted with each application for this assistance, in order to confirm in writing whether such certificates are indeed issued by them.

“Meanwhile, work that had already been planned continues, and simultaneously, the implementation of a new IT system begins, through which specialists will submit their certificates online using their e-ID, and then the internal application process will proceed,” government said.

The inquiry also recommended boards be allocated the needed resources to operate better. This includes a space where the board meets, as well as computer facilities where the board members can access the myHealth system.

In cases where the applicant cannot leave their home, the inquiry recommends that board members examine the applicant there.

The board also recommends apart from the MP5B application form, which lists the board and the secretary’s decision, official minutes of each sitting are recorded. Government has said it will carry out this recommendation.

The unit investigating abuse in benefits should no longer form part of the Income Support and Compliance Division, but report directly to the Office of the Permanent Secretary, according to the inquiry recommendations. Government has said that it will consider this recommendation.

It also recommends the drawing up of Standard Operating Procedures which serve as guidelines for the board members. Government has said it will carry out this recommendation.

Other recommendations include the periodical review of beneficiaries with non-visible disabilities and that doctors should declare any conflict of interest. Government has said it will carry out these recommendations.

Salient points

The ministry disclosed on Monday that a quarter of individuals who received benefits for severe disability between 2019 and 2022 were not eligible for them.

In its announcement accompanying the release of the evaluation board's report on the benefits granting process, the ministry stated that three out of every four recipients during the same period had valid claims.

Among the 288 individuals identified as fraudulently receiving benefits, they have been instructed to reimburse a total of €5.1 million, with €1 million already recouped.

The ministry highlighted that while an average of 71 fraud cases related to severe disability were discovered annually, the cumulative count of benefit fraud cases uncovered by departmental investigations between 2006 and 2023 amounted to 12,809 cases, averaging 712 cases annually, totalling €70.1 million.