Doctors who were appointed to medical panels to evaluate whether an applicant received the severe disability benefit or not did not check the authenticity of medical certificates, a board that was set up to look into the situation has found.
Nearly three hundred people were found to have taken the severe disability benefit when they were not entitled to it, according to the government.
News reports earlier this month read that former PL MP Silvio Grixti, who had allegedly provided false documents enabling people to receive benefits they were not entitled to, is expected to be charged in court. Parliamentary secretary Andy Ellul's former driver and canvasser was reported to have called for a magisterial inquiry to investigate the social benefits fraud racket, offering to blow the lid on organised criminal activity if granted whistleblower status.
In a statement on Monday, the Social Policy Ministry announced that the board that was set up on 13 September last year, has concluded its work.
The board was presided over by Judge Antonio Mizzi, along with Anthony Scicluna and Raymond Muscat.
The Board met 18 times, the government said, where it heard testimony from officials within the Social Policy and Children's Rights ministry under whom falls the responsibility of the paid benefits, employees who directly administered the boards that decided on respective benefits, as well as a number of doctors who form part of medical panels, the statement read.
"The board notes that, due to Covid-19, and while the department had began thinking about introducing a system where applications are filed online, the pandemic hastened the introduction of this process. This led to, inevitably, changing the way and procedure of how documentation, certificates and all requested information had to be submitted," the ministry said in a statement. "It clearly emerges that there was no change in the list of medical conditions that are acceptable."
The Board's report, which was attached to the government statement, reads that over the years there was a list of doctors appointed by the ministry to serve as members on medical boards that evaluated requests for different benefits, and that the number of doctors on a board after the pandemic reduced from three to two.
The statement said that after Covid-19, the medical evaluation process for an application changed. The location where the boards would meet moved from Mater Dei Hospital to the Bugeja Institute in Santa Venera. "The medical files at the hospital were no longer at the disposal of the doctors. The facilities and resources were limited, for example, it was not possible for a patient to be examined in the space provided. Another significant change, that could have left an impact, was that due to the pandemic, the applicants were asked to start submitting their applications, and all other needed documentation, online."
The board found that minutes by the evaluation boards were not kept. It found that for every application, a form is filled out with the recommendation of the panel, signed by the doctors on it and the board secretary. It also emerged through testimony that every applicant presents a medical certificate and other required documents. "It results that the panel doctors simply considered the certificates without entering into whether the certificate was authentic."
"It results from the testimony that every doctor on every panel would completely rely on the medical certificate produced by the applicant."
The board noted that the doctors faced with these certificates did not doubt their validity, content or the signatures of those who wrote them up.
"The doctors always assumed the certificates were genuine and issued correctly by those who signed." The reason for this was that, the board said, was that the panel doctors would reason that since the certificate was issued by a specialist, or a doctor who taught them at university, or was recognised by them, no suspicion that there could have been something irregular in the certificates would enter their minds.
Testimony also showed that the doctors who form part of the panels at no stage in the process were asked to declare whether they had a conflict of interest, the board added.
Recommendations
The board went on to issue its recommendations.
Firstly, it recommended that three doctors form a panel, rather than two, meaning that the number of doctors that form part of the existing pool needs to be increased "to avoid the practice that board secretaries would pick doctors based on availability." The ministry said that it will implement this recommendation.
Secondly, the board recommended that the department make an evaluation of the introduction of medical board specialised according to the disability.
The ministry said that it will undertake this evaluation, "in light of the fact that on the basis of an electoral manifesto promise" it is creating new structures, both legal and administrative, for the setting up of interprofessional boards, "where this board would be able to decide on disability cases according to the International Classification of Functioning, Disability and Health." Through this structure, the government said, the new interprofessional board would be able to decide on paid assistance for disabilities, as well as on particular services applicants might need and have a right to.
Thirdly, the board said that if the certificate issued by the specialist will remain the main document on which the board of doctors rests, the department must ensure that there would be strong controls that are consistently applied to ensure the validity and authenticity of the certificate presented by the applicant. "This needs to be addressed in the context of non-visible disabilities."
The ministry said it will implement this recommendation, and had started to do so in October, when instructions were given to the secretaries of medical boards to start verifying with specialists whose signatures appear on the certificate with each application.
The ministry added that work is ongoing to start operating a new IT system, through which specialists can submit certificates online using their eID.
Fourthly, the board recommended that in the case of non-visible disabilities, a review of the beneficiary occur every so often.
The ministry said it will implement this recommendation.
The board's fifth recommendation was that the medical boards should be given the needed resources to better operate. "This includes the location where boards meet, and the computer facilities so they can enter into the myHealth system. That is why applicants must give permission to the board to see their medical files."
The ministry said it would implement this recommendation.
The board's sixth recommendation was that the practice should be kept where, in cases wher ethe applicant cannot leave their homes, all members of the medical panel must go to examine the applicant in their home.
The ministry said that it will continue to implement this recommendation, "as is already happening."
The Board's seventh recommendation was that aside from the MP5B form, on which the decision signed by the doctors and the board secretary can be found, official minutes of each sitting must also be kept.
The ministry said it will implement this recommendation.
The seventh recommendation was that every doctor appointed to a panel must declare every conflict of interest.
Here, the ministry also said that it will implement the recommendation.
The board's eighth recommendation was that the unit that investigates abuse of all benefits should no longer form part of the Income Support and Compliance Division. "It is suggested that this unit start reporting directly to the office of the Permanent Secretary."
The ministry said that it will consider the recommendation. "It must be said that when the directorate merged with the Income Support and Compliance Division, it resulted that the directorate improved alot. While in 2012 548 people were caught abusively taking benefits amounting to €2.8 million, in 2023 894 people were caught abusively taking benefits amounting to €5.9 million."
"It must also be said that it was thanks to joint work in this division which led to the uncovering of suspicious medical certificates, that led to the police widening its investigation that it was already conducting after a case was referred to it by the Prime Minister's office."
The board's final recommendation was that Standard Operating Procedures need to be drawn up, to serve as guidelines. "These SOPs must reflect every change that occurrs in the processes and procedures. These should be given to every member of any medical board when appointed."
The ministry said that it will implement this recommendation.
The ministry said that the Office of the Prime Minister had referred the first suspicious case in November 2021, and that since December 2021, officials within the Income Support and Compliance Division have been working together with the police to investigate every case of severe disability benefits given since 2015.
These investigations, the ministry said, "that are now reaching their end, led to 288 cases of such benefits being stopped on the instruction of the police, steps were taken against the people concerned and they were asked to refund what they wrongly took."
The ministry said that nearly all of the cases where benefits were stopped involved beneficiaries who started taking benefits beterrn 2019 and 2022, except for two cases, one who started in 2016, and another in 2018.
"It results that of all those who took this assistance between 2019 and 2023, three of every four people were given the benefit because they were entitled to it and genuine."
"The number of people who cheated the system is much lower than the numbers that were being mentioned publicly for a time."
The 288 people who were caught taking benefits fraudulently, the ministry said, need to refund €5.1 million in total, of which a littme more than €1 million was already collected. The average age of those caught abusing between 2019 and 2022 is 71, it samd.
The ministry said that all the cases of social benefits abuse caught through regular and continuous investigations by the ministry between 2006 and 2023 amounted to 12,809 people, which amounted to a total of €70.1m.