Articles and Case Studies

How do you deal with fake medical certificates

01 Jun 2022

by Tanith Chippendale

A GP was incensed to find that a patient had falsified a COVID-19 exemption certificate in the GP’s name and presented this to their employer. A call from the patient’s employer posed several dilemmas for the GP.

Can the GP speak to the employer without breaching confidentiality?

What effect will this have on the doctor–patient relationship?

Is the GP obliged to contact the police?

In an already frustrating situation, medico-legal concerns can add to the stress.

 

General practitioners frequently come across situations where they are asked to verify whether a document was prepared by them, only to find the document has been forged. This can be a stressful and confronting circumstance for which you may need to seek advice.

Validating documents and duty of confidentiality

You are able to validate to the requesting party which certificates you have (or have not) provided. This would also include confirming that a particular certificate was not produced by the practice or doctor on the date it was apparently prepared, or why the document appears to be a forgery.

Patient confidentiality prevents you from discussing any clinical consultation(s) or the patient’s medical history with the requesting party, beyond confirming the validity of any genuine certificate(s) the patient may have presented.

A brief factual note should be made in the file to document that you have been contacted by the requesting party and how you have responded.

Should you contact the patient?

You do not have a duty to discuss the matter with the patient. Contact with the patient might be appropriate where there is a matter of patient care involved (e.g., a concern that the fraud is a manifestation of a mental health issue that needs addressing). You do not know all the facts of the matter and there may be more to it than is initially evident.

Do you have to tell the police?

No. Doctors generally have no mandatory reporting requirements in relation to alleged less serious criminal activity. The requesting party may be in a better position to do this in any case.

You are able (but not required) to disclose information regarding suspected unlawful activity to the police under the Commonwealth Privacy Act(1988) – Australian Privacy Principle (APP) 6. This APP recognises that a health service provider may wish (or be required by law) to report suspected unlawful activity – and this may involve the release of confidential information. The minimum disclosure possible should be made to allow the matter to progress. The police can then issue a warrant, summons or equivalent to compel the production of additional material. This may be more likely if the fraud has been perpetuated against you personally, i.e., the patient has stolen your identity beyond a fake certificate.

If you were to take such action, please liaise with our medico-legal advisers before sending out any correspondence as certain obligations may apply, e.g., keeping a written record.

Should you continue to see the patient?

There is generally no obligation to see any patient in private practice (excepting an emergency situation), although the reason for refusing care must not be discriminatory.

Ultimately, this will be a very personal clinical judgement that balances the need for a therapeutic relationship with the patient and their health needs against the significance of the apparent fraud and loss of trust. Some practitioners agree to try to assist the patient moving forward, while others prefer to terminate care.

Ending care

Many patients decide not to return to the practice, once they know the practice has confirmed the fraudulent behaviour. Continuity of outstanding significant clinical care should be considered, and steps put in place to manage this if ongoing care unexpectedly ends. This might involve forwarding records or sending the patient specific advice and/or results to take to their new practitioner.

Risk management

Fraudulent actions by patients are difficult to prevent, but you should take the time to review the circumstances in case there are any risk mitigation steps the practice can take to prevent similar occurrences.

 

Our medico-legal advisers are happy to assist with queries regarding fraudulent documents, including advice on the subsequent management of patient care.

 

Subscribe to MDA National’s biannual Member publication, Defence Update, for the latest medico-legal updates, articles and case studies here.


Communication with Patients, Confidentiality and Privacy, Clinical, Complaints and Adverse Events, Consent, Medical Records and Reports, Practice Management, Regulation and Legislation, Dermatology, Emergency Medicine, General Practice, Obstetrics and Gynaecology, Ophthalmology, Practice Manager Or Owner, Psychiatry, Sports Medicine, Surgery, Physician, Geriatric Medicine, Cardiology, Plastic And Reconstructive Surgery, Paediatrics, Gastroenterology
 

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