AXA Health investigation safeguards patients

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The patient-focused scrutiny of AXA Health teams helped bring the ‘inappropriate clinical procedures’ of a respiratory specialist to tribunal.  

North-eastern consultant Dr Ian Taylor has agreed never again to practise in the private sector following a nine-month suspension imposed by the Medical Practitioners Tribunal Service. 

The tribunal found Dr Taylor was ‘dishonest’ and engaged in clinically inappropriate actions in his ‘very busy private medical practice’, ‘much of which … was funded by health insurance provided to patients by AXA [Health]’. 

In 2017, an AXA Health Customer Service employee was contacted by a patient who’d received an unexpected bill from Dr Taylor for a review of diagnostic tests. Generally, fees for reviews are covered by the hospital.  

The AXA Health employee took the complaint to the company’s Provider Audit & Investigations team, which started the lengthy process of reviewing the medical notes and data in Dr Taylor’s treatment and invoicing history.  

As the case progressed, AXA Health engaged expert advice and interviewed patients to better understand Dr Taylor’s practice. The company also contacted the senior governance leads at the north-eastern NHS hospitals where Dr Taylor practised, discovering that they were also investigating the specialist for similar concerns. In 2019, AXA Health referred the case to the GMC. 

Lead investigator Tim Crick said: ‘As the investigation went deeper, it was apparent that he was not only billing us for treatment he knew was not eligible, but worse still, he was carrying out treatment that was not medically necessary, including invasive bronchoscopies and CT scans. For our members and for AXA Health, there were financial and medical consequences. 

‘Studies have shown how overtreatment is associated with direct harm to patients, and it is also to our customer's financial disadvantage if they have out-patient limits. Dr Taylor's behaviour was also inflating AXA Health’s claims costs, which has the knock-on effect of higher premiums for our members.’ 

Commercial director Fergus Craig said: ‘We take patient safety, and the nature of the care our members receive, extremely seriously. This case shows the importance of data analysis in our work, as well as demonstrating the high level of collaboration between our different departments – what seemed to be a minor billing issue turned out to be something far more concerning.  

‘Because we want to ensure good outcomes for our members, as well as protecting their subscriptions, we do check for unusual billing, or treatment patterns that lie outside the norm. Where we can, we share what we’ve found, as encouraged by the Paterson inquiry findings and the Acute Data Alignment Programme (ADAPt), and in the spirit of the Competition and Markets Authority’s (CMA) Private Healthcare Market Investigation Order 2014.  

‘We also encourage a ‘speak up’ culture and have a confidential hotline for any concerns: 0800 206 1805.’