The National Health Service (Ophthalmic Services) (Wales) Regulations 2023

Factors relating to fraud cases

16.—(1) Where a Local Health Board is considering whether to remove a qualified practitioner from its combined list under section 107(3) of the Act (disqualification of practitioners) or under regulation 17(3)(d) of these Regulations, in relation to a fraud case, it must—

(a) consider any information relating to the qualified practitioner which it has received in accordance with any provision of Part 2 of Schedule 3 or Schedule 4,

(b) check with the Welsh Ministers for, and consider, any facts that the Welsh Ministers consider relevant relating to past or current investigations or proceedings involving or relating to the qualified practitioner, and

(c) in reaching its decision, take into consideration the matters set out in sub-paragraph (2).

(2) The matters referred to in sub-paragraph (1)(c) are—

(a) the nature of any cases of fraud;

(b) the length of time since the last case of fraud occurred and since any investigation into it was concluded;

(c) whether there are other cases of fraud or other offences to be considered;

(d) any action taken by any licensing, regulatory or other body, the police or the courts as a result of any such offence, investigation or case;

(e) the relevance of any investigation into a case of fraud to the qualified practitioner’s provision of (or assistance in providing, as applicable) primary ophthalmic services and the likely risk to patients or to public finances;

(f) whether the qualified practitioner has been refused admission to, conditionally included in, removed, or contingently removed or is currently suspended from, a primary care list or equivalent list, and, if so, the facts relating to the matter which led to such action and the reasons given by the Local Health Board or equivalent body for such action;

(g) whether the qualified practitioner is, has in the preceding 6 months been, or was at the time of the originating events, a director of a body corporate, which was refused admission to, conditionally included in, removed or contingently removed from, a primary care list or equivalent list, or is currently suspended from any such list, and if so, what the facts were in each such case and the reasons given by the Local Health Board or equivalent body in each case;

(h) in the case of a corporate optician, whether a person who, at the time of the originating events, was one of its directors, has been refused admittance to, conditionally included in, removed, contingently removed or suspended from a primary care list or equivalent list and, if so, the facts relating to the matter which led to such action and the reasons given by the Local Health Board or equivalent body for such action.