They say they are branded racist by bosses if they speak out on the issue

The ‘vast’ scale of health tourism in the NHS is being covered up by hospital bosses, whistleblowers have told the Mail.

The managers say they are told to disguise the true number abusing the health service by bosses who ‘don’t want to know’ – and are branded racist if they speak out.

Foreign patients can use NHS-issued cards to obtain treatment abroad, funded by UK taxpayers, the Mail revealed yesterday.

But it emerged last night that the Government has known about ‘concerns’ over EHIC card fraud for months – yet failed to act and still issues more than five million a year.

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NHS managers say they are told to disguise the true number abusing the health service by bosses who 'don't want to know' and are branded racist if they speak out

Health Secretary Jeremy Hunt was warned 18 months ago about a loophole allowing foreign nationals to charge the NHS for medical treatment in their home countries.

A report published in October 2013 warned migrants were using EHIC cards after applying for them under false pretences. The health tourism report revealed NHS staff tasked with rooting out abuse were warning about the ‘system and application process’ being misused by foreign nationals.

It said: ‘Several … commented that visitors from EEA countries sometimes present a UK EHIC card and they were concerned that … people concerned would then return home and access healthcare which they previously would not be eligible for with the cost being met by the UK taxpayer.’

Labour’s shadow health minister Andrew Gwynne said: ‘Ministers need to come clean about when they were first aware of this problem, and how widespread it is. Any evidence of people abusing the NHS must be tackled and taken seriously. There can be no room for complacency.’

Today, managers charged with cracking down on health tourism, overseas visitor officers, reveal they are being ‘treated as a nuisance’ by bosses. Six of them bravely agreed to be interviewed – despite fearing they could lose their jobs as a result. They told how:

Some foreign kidney patients have used NHS dialysis machines for more than five years without paying – costing more than £200,000 each

A woman from West Africa flew to the UK five times to have each of her babies on an NHS ward before staff realised she was a health tourist

British patients are missing out on life-saving organ transplants because health tourists are coming here to get them

Bosses would rather ‘turn a blind eye’ as retrieving the money owed is ‘too difficult’

Even some doctors are complicit, flying foreign relatives from abroad to have expensive operations for free on the NHS.

Health Secretary Jeremy Hunt was warned 18 months ago about a loophole allowing foreign nationals to charge the NHS for medical treatment in their home countries

The managers, speaking on condition of anonymity, said bosses would rather not know how many health tourists were using hospitals because these patients have to be chased for money. Such patients rarely pay, leaving the trust with a debt.

One whistleblower said: ‘If we declare them to be health tourists, we can’t claim the full amount of money from the Government for their treatment … Vast numbers of people abusing the NHS are never identified because of this.’

Another officer working in a different part of England said her hospital bosses ignored health tourists to avoid costly legal battles with them.

‘Bosses are so frightened of litigation that … they say, “Don’t bother with that one.”’

Two of the whistleblowers said they were branded ‘racist’ for raising concerns about health tourism. All of them told of abuse of NHS resources on an astonishing scale. One said she had been bullied by a consultant wanting his father from overseas to have an operation on the NHS.

Cancer surgeon Meirion Thomas said the accounts were ‘profoundly disturbing’, adding: ‘It is clear they are being asked to turn a blind eye to the abuse of NHS resources in a way that is completely unacceptable.’ The exact cost of health tourism to the NHS is unknown. The Government has put the figure at about £200million, but senior doctors say it is far higher.

The UK’s system for flagging up foreign patients sees them treated before hospital staff try to claw back costs. In France, Germany and Scandinavia patients must pay in advance.

It means hospitals across England are targeted by thousands of health tourists a year.

The job of overseas visitor officers is to identify which patients are not eligible and charge them. Hospitals are meant to employ at least one officer but many do not and diligence varies between trusts.

A Department of Health spokesman insisted the Government was taking ‘tough measures’ on health tourism.

He said hospitals had been given new financial incentives to chase money from culprits and rules were being introduced to protect whistleblowers. He added that ‘we have also introduced new measures to prevent fraud and error’.

Abusing the NHS 'is the easiest thing in the world': Six hospital watchdogs say bosses don't care about fraud

by SOPHIE BORLAND AND KATHERINE FAULKNER

The Mail interviewed six NHS managers whose role is to identify health tourists and try to make them pay for the care received.

But they said their job was made almost impossible by hospital bosses who have no interest in cracking down on the problem.

Only about a quarter of those abusing the NHS are flagged up, the managers revealed, and of those identified, only 15 per cent pay.

The women also spoke of how they had been bullied by doctors trying to bring family members to the UK for free NHS operations. To protect their identity, we have used pseudonyms. Here are some of their stories.

‘You’re branded racist and nobody does anything’

MARY: Abusing the NHS is the easiest thing in the world. But if you say the NHS’s deficit is partly to do with health tourism, people say … you’re being racist.

It’s just dismissed and nobody does anything … Nobody wants to admit the scale of it. I went to one meeting with a very senior NHS manager and those of us trying to talk about health tourism were shouted down by everybody.

'Who pays for it all in the end? The taxpayer': One worker said she was branded racist if she dared to suggest that part of the NHS deficit was due to health tourism

Hospitals close to airports are the ones that get targeted for maternity tourism. We call it the Lagos Shuttle because many of the women come from Nigeria … It’s very easy to get a visitor’s visa and do it. Some hospitals only pick up on it on the woman’s fifth baby.

A lot of hospitals are so frightened of litigation they’ll tell staff to ignore health tourists … The problem is that abusing the NHS is so easy. Anyone can just walk into a GP surgery and get an NHS number.

Once someone has an NHS number, the hospital knows that the NHS will pay in full. Who pays for it all in the end? The taxpayer.

‘Hospital bosses would rather turn a blind eye’

DEBORAH: My job is to identify patients who are not entitled to free NHS care. But some hospitals prefer for those patients not to be identified … because if we declare them to be health tourists, we can’t claim the full amount of money from the Government for their treatment – and that means debt for the trust.

The fewer patients you identify as health tourists, the less debt a hospital will have, so bosses would rather turn a blind eye … Vast numbers of people abusing the NHS are never identified. We don’t have a real picture of how big the abuse is … Those of us who try to crack down on it are seen as a nuisance. You are told you are racist and it isn’t as big as you are making it out to be.

There are cases where doctors bring in their own family … I was really pressured by consultants into letting a doctor’s father from overseas have an elective operation for free.

Maternity treatment is always classed as ‘immediately necessary’ … we can’t say, ‘you’re very well, go home and have your baby’. We would be breaking the law.

If someone who lives abroad needs an organ, they can come to the UK and go top of the list if they are most in need … they will never pay.

We had someone who came to the UK on the premise of paying for a liver transplant … The bill was in excess of £30,000 and the taxpayer paid it. But that’s not the point. [The point is] someone didn’t get a liver because of that.

Many pregnant eastern European girls come to the UK and within weeks are given an EHIC card

‘Girls come here and get an EHIC in weeks’

ANGELA: Many pregnant eastern European girls come into the UK, and within a couple of weeks, they have an EHIC card … One girl said she will go back home and have care there using her UK EHIC, paid for by the NHS.

We then get the mothers and fathers of these girls coming in for free NHS treatment for long-term conditions … They are all abusing the system.

‘Doctors bring family to the UK for free care’

SANDRA: Recently, a GP referred a patient to us for quite a complex cardiology operation … When the GP went to ask the patient how he was, the person said, ‘oh no, that wasn’t me, I brought my brother over from India’. The GP knew about this but didn’t report it … my bosses were not in the slightest bit interested in pursuing it.

If you stole a printer from a hospital they’d come down on you like a ton of bricks. But if you bring someone over for a £10,000 operation they are not really bothered.

In my hospital, we identify ten to 15 patients every week who are not entitled. There are probably others we never identify … we very rarely get money. Very rarely can they speak English, so there’s the translation as well. That’s a huge cost.

There’s a real lack of support from managers. Patients who are challenged go to solicitors, and … the NHS managers get very frightened and back off even if we are right to charge … I have been told by a previous manager that if a patient has an NHS number, we are not to pursue them even if we know they are not entitled. Bosses know the taxpayer will always pay up.

There is also a lack of support from doctors. We have even had doctors at the hospital who have tried to bring relatives over for free treatment, probably four or five cases over the past couple of years.

‘No one talks about the impact of migration’

BARBARA: In my hospital, we see hundreds of people every week trying to take advantage …

Eastern Europe is one of the worst offenders for maternity tourism. I see no end of girls who sign up as agency workers already pregnant.

They get the Sure Start maternity allowance … and all the other maternity benefits … Midwives even give them the forms for child benefit.

They’ve totally cracked the system. We are … an international health service. We know the NHS is haemorrhaging money due to this. They blame the elderly, they blame mental health, but nobody talks about migration and the impact it’s having … I have fought with the Department of Health, with my own trust, trying to get people to realise that this is an increasing problem.

The managers have never been interested. It is utterly soul-destroying.

People say, ‘well, the NHS is free, isn’t it?’ But free for who?': One worker said overseas patients had been receiving dialysis at a cost of £40,000 a year

‘Taking the spaces of people lawfully here’

VALERIE: At my trust, we have several overseas patients all getting kidney dialysis … None are eligible for free NHS care, but not one is paying.

One of them has been getting dialysis three to four times a week … at a cost of £40,000 a year, for more than five years now. They have not paid a penny.

They have been served with removal papers, so we tried to medically repatriate … but they just put in more applications. We do bill them, but they’ve got no money.

With someone who requires dialysis, you can’t refuse it, because it’s life-threatening … These patients are keeping beds, taking the spaces of people who are lawfully here. The local people have to go elsewhere.

People say, ‘well, the NHS is free, isn’t it?’ But free for who?

Nigerian mother found guilty of using British woman's identity to have baby at our expense is still here - and hasn't paid back a penny of £3,500 it cost to deliver the child

by LUCY BORLAND, MAIL INVESTIGATIONS REPORTER

Deceit: Oluwaseun Adenubi with the child she gave birth to on the NHS

A Nigerian mother found guilty of using a British woman’s identity to give birth on the NHS is living on state handouts in London.

Oluwaseun Adenubi, 30, used the passport of Rita Ogunkunle, to obtain free medical care during the delivery of her son Moses.

She then allowed Ogunkunle, 32, and partner Michael Adebambo, 46, to register as Moses’s parents to get him free NHS care and a UK passport, a court heard in January.

Judge John Tanzer described the case as ‘a Nigerian plot to use the “International Health Service” and then take further advantage’.

Adenubi came to London when pregnant in 2014 on a family visit visa, which allowed her to stay for up to six months.

But the Mail can reveal that despite overstaying her visa and being handed an eight-month suspended prison sentence for fraud, Adenubi is still in the UK. She has not repaid a penny of the £3,500 it cost to deliver her baby, and she continues to receive free NHS care for herself and her son, now one.

The mother of one lives in a two-bedroom semi-detached house – paid for by the taxpayer – in an east London suburb, receiving around £9,000 a year in state handouts.

Suspicions were raised in spring last year when Adenubi registered at Farnborough’s Princess Royal University Hospital.

Staff noticed that the new patient, with documents naming her as Rita Ogunkunle, did not tally with NHS records for the woman of that name. They also realised her blood type did not match what they had on record, so asked her to be re-tested.

But the real Ogunkunle allegedly went in Adenubi’s place, so the new blood test matched the original record. When Adenubi gave birth, she needed a Caesarean section, which involved a blood transfusion. Luckily, her blood type was tested before the procedure and she was given the correct type – but this led to more confusion.

After Moses was born on June 20 last year, staff questioned her about the mix-up and Adenubi confessed that she had lied.

Last night, she told the Mail she ‘can see why people are annoyed’, adding: ‘I know what I have done is wrong … I plan to pay it back. Obviously I’m trying to sort everything with my papers and when I do get a job, I’ll only be able to pay it back in bits, but I will.’

The asylum seeker, who has no family in the UK, is not allowed to work here until her refuge is granted.

When she arrived in Britain, Adenubi ‘went from hospital to hospital’ trying to get treatment, she said, but was rejected by staff who told her she was not eligible. She said she ‘had to’ give birth in a hospital so decided to use someone else’s identity.

The asylum seeker, who has no family in the UK, is not allowed to work here until her refuge is granted

The Nigerian said she fled her home country because her son’s father abused her.

Nigeria offers free maternity care but the quality is very poor and there is a high mortality rate. Now, Adenubi is entitled to free prescriptions, free dental care, free eyesight tests and help paying for glasses – on top of being able to see a GP or get hospital treatment whenever she requires.

When Ogunkunle was arrested in August last year, she claimed Adenubi took the passport after moving into her spare room. But Adenubi denied that she ever knew Ogunkunle or her partner, saying she ‘found their papers on a park bench’.

Ogunkunle and Adebambo were handed eight-month suspended prison sentences for fraud by false representation.

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Alexandra Bushell, prosecuting, told the court Ogunkunle ‘admitted falsely registering the birth of the baby and said she had been introduced to Adenubi by a friend of her mother’s and took pity on her … She told police she was angry at Adenubi using her identity and tried to beat her to it by registering the child.

‘[Adebambo] said his girlfriend asked him … to register a birth … He said he did it out of love for [her] and was very remorseful.’

A spokesman for King’s College Hospital NHS Foundation Trust, which runs the hospital where Adenubi was treated, said: ‘We are still working to recover monies owed in this case.’

Scourge costs us billions a year: Commentary by J Meirion Thomas

Hungarian journalist Ani Horvath was able to obtain a European Health Insurance Card after visiting the UK for less than one day

Health tourism is the scourge of the NHS.

At a time when the service is under severe financial pressures, it not only costs the Government a fortune but also undermines healthcare for British patients who have contributed to the system through their taxes.

The full expensive absurdity of this problem has been highlighted in this week’s brilliant investigative reports.

Yesterday the Mail revealed how an undercover reporter living in Hungary easily acquired a European Health Insurance Card (EHIC), thereby ensuring the NHS would pay for her medical treatment anywhere in Europe; today it discloses how the NHS is ‘haemorrhaging’ money to health tourists – and how the problem is being ignored at best, or covered up.

The founding principle of the NHS was that its care should be ‘free at the point of use’, but that noble ethos is now systematically abused on an epic scale.

Health tourists are defined as people who come to Britain with a pre-existing illness and whose motive is to receive free treatment on the NHS.

Contrary to the scaremongering from the politically correct brigade, the term ‘health tourism’ does not apply to overseas visitors who suffer an accidental injury or suddenly become ill.

Nor is it applicable to asylum seekers or disadvantaged migrants who are generally entitled to NHS care.

What we are talking about is cynical exploitation of the service by ineligible foreigners. I became aware of the seriousness of this issue through my work in the NHS as a surgeon, specialising in the treatment of cancer. I kept coming across cases that showed both the increasing prevalence of health tourism and the indifference of the authorities towards tackling it.

In one typical example, a Greek resident – whose son lived in the UK – arrived with CT and MRI scans that had been recently performed in Athens.

Since these scans had been carried out under medical supervision in Greece, I wondered why the patient was being treated here rather than in his home country. Despite expressing my concerns, he was accepted for free NHS care.

I was so outraged at the catalogue of abuse that in 2013 I went public with my concerns through articles in this newspaper and other publications. The massive response – particularly from staff working in the NHS – demonstrated that the problem was even worse than I had imagined.

One doctor claimed every week he saw people who had been flown in from all over the world with a variety of serious health problems, many of whom had been ‘wheel-chaired’ onto the plane because they were too ill to walk.

At the Budapest ophthalmologist clinic: Staff did not check for 'emergency' symptoms and accepted the cars

The most powerful testimony came from the NHS hospitals’ Overseas Visitor Officers (OVOs), many of whose shocking revelations are contained in the Mail today. These are people who have the difficult job of identifying and charging ineligible patients for treatment they have received – and in this capacity they witness the exploitation and mismanagement at first hand.

One told me how a heavily pregnant Nigerian woman referred herself to the hospital’s maternity service. She had had IVF in Nigeria and came to Britain on a visitor’s visa to give birth to her triplets. Because she had visited the UK regularly for 15 years, she believed was entitled to free care.

What we are talking about is cynical exploitation of the service by ineligible foreigners

Many of these NHS workers complained to me bitterly about the reluctance of politicians or senior managers to tackle the problem. Indeed, at times the authorities almost seem to collude with it.

The refusal to face up to reality is illustrated by the Government’s instinct to downplay the financial burden of health tourism.

Earlier this year the Health Secretary Jeremy Hunt put the total cost at just £200million a year. But Mr Hunt’s figure seems to me absurdly low. From my own analysis, I believe that the true sum is about £3billion a year.

How did I come to my figure? Well, for a start, it is based on the fact that the entire culture of the NHS militates against a robust charging system. Rather than billing foreign patients, hospitals usually find it easier, quicker and more reliable just to recover their costs from the NHS Clinical Commissioning Groups which authorise the treatment.

In practice, given that the Groups are funded entirely by the State, this means that British taxpayers are picking up the tab. Even when invoices are sent to foreigners, little effort is made to chase up payment. Moreover, the invoices that are paid grossly understate the real costs to the NHS. They are based on a financial measurement called the ‘NHS tariff’, which is a minimal, heavily subsidised amount covering the bare bones of each treatment.

So, for instance, a recent NHS tariff for an uncomplicated obstetrical delivery (childbirth) was £2,820. An equivalent package in the private sector would cost £12,000. Similarly, the NHS tariff for complex abdominal surgery is about £7,000 but would cost £40,000 in the private sector.

At the maternity centre: Advice on how to have delivery costs covered 'even if it is not an emergency'

Add to this the fact that – as yesterday’s investigation reveals – the NHS pays not only for treatment in Britain but also for healthcare across Europe, and you begin to realise why the official figure is a woeful underestimate.

There is a fashionable belief, sedulously cultivated by some pro-European ideologues, that health treatment is free throughout the member states of the EU, as long as a patient possesses a European Health Insurance Card (EHIC). But this is a myth. Mainland Europeans are only entitled to such a card in their own countries if they or their employers contribute to their native national insurance scheme.

Even then, a valid card may be issued for only weeks or months, and some nations – including Belgium, France and Germany – insist that patients from other countries still pay 20 to 30 per cent of their medical costs.

The contrast with Britain could hardly be greater. Any European national who claims to be resident in the UK simply needs to provide an address and an NHS or National Insurance number to apply for a British EHIC.The card, valid for five years, will be sent in the post within days, entitling the applicant – who may only be temporarily resident – to free health treatment anywhere in Europe.

Our politicians need to take their heads out of the sand. Health tourism is almost uniquely a British phenomenon because other countries with comparable health services have a strict method of personalised patient identification to determine entitlement to free care.

We need the same in Britain. Hospitals and GPs should be obliged to insist on payment from patients who cannot prove their eligibility. To this end, it would be perfectly reasonable to ask patients, when registering for their first hospital or GP appointment, to provide some photo ID, together with a recent utility bill.

Exactly as is required to access any financial service, open a bank account or even get a bus pass.