• Trust admits it has “significant problem with coding” going back years
  • CCGs presented with an unexpected invoice for £13m
  • Wandsworth CCG is resisting paying “in the strongest possible terms”

A major teaching trust has presented its commissioners with an unexpected £20m bill after discovering it has been inaccurately coding its activity “for a number of years”.

St George’s University Hospitals Foundation Trust says the invoice is for work undertaken in 2016-17 only.

Wandsworth CCG, the lead commissioner for St George’s, is resisting paying its share of the bill “in the strongest possible terms”, according to March board papers from Merton CCG.

The CCGs have been invoiced for £13m in total, and £7m has been invoiced to NHS England for “specialised services”.

Attempts to negotiate a reduced payment with the trust have not been successful, the board papers said: “The combined CCGs’ offer has been rejected by the trust with a £4.5m gap currently existing. Negotiations continue at the time of writing.”

The trust launched a clinical audit in 2016 following complaints from clinicians about accuracy of coding.

The audit showed that the trust had “a significant problem” with its coding going back several years.

“We have not coded complex patients as well as we should. There is some work for which we have failed to charge at all,” a trust spokesman said.

“In-depth analyses by the trust shows that in trauma and orthopaedics, for example, we uncovered discrepancies in coding which meant work was being coded, and charged, at a much lower level than it should have been and this resulted in a £300,000 shortfall in just one month.”

After discovering the scale of the problem, the trust increased the size of its clinical coding team from 11 to 25. It is also reviewing its operating processes, and providing additional training and support for clinical teams.

The trust spokesman said it faced a challenge in “upskilling” clinical teams in recording data.

He added: “We are in discussions with our commissioners about payment for activity undertaken during [2016-17] and expect a resolution shortly.”

A senior source at the trust acknowledged that the decision to back-charge was causing concern with commissioners, but said: “We work in a system where purchaser and provider split. Our job is to send an accurate bill. It can’t be right that this trust subsidises other trusts that are better at coding.”

Back-charging for poorly coded activity “rebalances things”, they added.

A spokeswoman for Wandsworth CCG said the invoice was informal and the issue would not require action until a formal invoice was issued.

Merton CCG said: “We are discussing this with Wandsworth CCG and with the trust. There is currently not enough information regarding the sum suggested in the pro forma invoice sent to Wandsworth.”