Counter Fraud

Fraud and bribery in the NHS is unacceptable. Fraudulent activity diverts time, money, and resources away from patient care and puts patients at risk. It is important that funds that are intended for healthcare are used for the benefit of NHS patients, and the CCG, therefore, takes a zero-tolerance approach when tackling fraud.

NHS Counter Fraud Authority (NHS CFA) works to identify and tackle crime across the health service. The aim is to protect NHS staff and resources from activities that would otherwise undermine their effectiveness and their ability to meet the needs of patients and professionals. Ultimately, this helps to ensure the proper use of valuable NHS resources and a safer, more secure environment in which to deliver and receive care.

The role of the counter fraud team is to implement the NHS fraud: Organisational strategy 2020-2023 within the organisation and to investigate professionally, any suspicions of fraud or bribery that may arise.

The NHS widely recognises that the vast majority of staff and patients are honest. Unfortunately, there is a small minority against which action has to be taken to reduce the risk of fraud.

Local Counter Fraud Specialists:

Matt Wilson
Tel: 07484 040 691
E-mail: matt.wilson2@nhs.net

Kirsty Clarke
Tel: 020 3201 8054
E-mail: Kirsty.clarke8@nhs.net

Amanda Kalawa-Conteh
Tel: 0203 201 8453
E-mail:  Amanda.Kalawa-Conteh@nhs.net

Training

The LCFS holds a monthly session for new starters at the CCG, as part of the corporate induction. 

Please contact matt.wilson2@nhs.net or Amanda.Kalawa-Conteh@nhs.net, if you would like a specific session for your team from the LCFS.

What is fraud?

The main offences of fraud are currently contained within the Fraud Act 2006, which was implemented on 15 January 2007. Fraud is committed when someone intends to dishonestly gain money, goods or services for themselves. This can be through false representation (written, verbal or implied) by failing to disclose information when requested, or by abusing a position of trust.

  • Fraud by false representation (Section 2 of the Fraud Act 2006)

Example: An individual lies by providing misleading information on their application form that they have the right to work in the United Kingdom in order to obtain employment. In this instance, the person has made a false representation in that they are legally allowed to work in the UK and intend to make a gain for themselves in the form of their salary. 

  • Fraud by failure to disclose (Section 3 of the Fraud Act 2006)

Example: A person fails to mention on their job application that they lost their previous job due to a criminal conviction, or have been subject to a previous regulatory sanction.

  • Fraud by abuse of position (Section 4 of the Fraud Act 2006)

Example: A person holding Power of Attorney withdraws money from a patient’s PHB account for their own personal expenditure.

The maximum penalty that can be imposed for someone who has committed fraud is ten years imprisonment.

Fraud prosecutions in the NHS

Westminster Dentist sentenced for fraud

A fraudulent dentist who owned practices in London and Surrey has been sentenced at Southwark Crown Court, following a fraud investigation led by the NHS Counter Fraud Authority.

Dr Sheena Lalani defrauded the NHS of over £74,000 and was sentenced to 20 months’ imprisonment suspended for two years, ordered to carry out 250 hours of unpaid work, given a 20 day rehabilitation order and ordered to pay £662.00 of NHSCFA costs within 3 months.  In addition, she repaid a total of £87,298.37 to account for inflation.

IT manager sentenced for £800,000 fraud

Essex IT manager, Barry Stannard, was sentenced to 5 years and 4 months imprisonment for defrauding the NHS and HMRC of over £800,000.

The hundreds of invoices submitted by Stannard’s companies were all individually for relatively modest amounts, meaning he was authorised to sign them off without further checks.

On the invoices he submitted, he also charged for VAT which was never forwarded to the HMRC. The VAT registration number quoted was false and related to another legitimate company. The VAT he charged the NHS totalled £132,000. This is included in the total of £806,229.80 that Stannard defrauded the NHS.

Bribery Act 2010

The Bribery Act reformed the criminal law to provide a new, modern and comprehensive scheme of bribery offences that enables courts and prosecutors to respond more effectively to bribery committed within the UK or abroad. The Bribery Act applies to all individuals living in and corporates (irrespective as to what happens to any profit) based or operating in the UK. The Act covers all sorts of bribery, directly or indirectly, whether or not this involves a public official, in the UK or abroad.

What is a bribe? 

A bribe is defined as a ‘financial or other advantage’. There is no minimum value; it can include cash, hospitality, a gift, a facilitation payment; it can be offered with the intention of inducing improper behaviour, or knowing acceptance would be improper.

What are the penalties?

  • A criminal prosecution carries a sentence of up to ten years imprisonment
  • Organisations can receive an unlimited fine
  • Disbarment from National contract tenders
  • Reputation is ruined by allegations of bribery and corruption.
What should you do if you suspect fraud?

Do:

  • Report your concerns to either the LCFS or the Chief Finance Officer as soon as possible. Any delay may cause the organisation to suffer further loss
  • You can also report directly to the CFA here
  • Make a note of your concerns
  • Note all relevant details – what was said, significant dates, times, and names of all parties involved
  • If possible, retain copies of relevant documentation i.e. anything that aroused your suspicion and supports your allegation

Don’t:

  • Confront the individual directly
  • Try to investigate the matter yourself
  • Contact the police directly or undertake your own surveillance
  • Convey your suspicions to anyone without appropriate authority to investigate
  • Do nothing!
Reporting your concerns

Should you have a concern or suspicion relating to fraud, corruption or bribery within the CCG, or need advice, email or call the CCG’s Counter Fraud Team: 

Matt Wilson
Tel: 07484 040 691
E-mail: matt.wilson2@nhs.net

Amanda Kalawa-Conteh
Tel: 0203 201 8453
E-mail:  Amanda.Kalawa-Conteh@nhs.net

You can also contact:

  • Simon Goodwin, North Central London CCG’s Chief Finance Officer
  • The NHS Counter Fraud Authority via their website or call the corruption reporting line on 0800 028 40 60 
Remember...

Suspicions of fraud, corruption or bribery should only be reported to those with the appropriate authority to investigate fraud; suspicions of fraud should not be reported to a friend, colleague or your line manager. All referrals will be treated in confidence.

Should you wish seek advice and guidance before reporting a suspicion of fraud, corruption or bribery then you can contact Protect via their website or call them on 020 3117 2520. Protect is a registered charity that provides employees with advice on whistleblowing.

Confidentiality

The counter fraud team and North Central London CCG are committed to the confidentiality of any information reported in relation to a potential offence of fraud, corruption or bribery and therefore any information reported will remain in confidence. In some instances you may be asked to provide evidence in court; however the counter fraud team will seek your permission and liaise with you throughout. The Public Interest Disclosure Act 1998, provides statutory protection from any repercussions for all members of staff who raise a concern in good faith, using the Whistleblowing Policy. For more information on how the organisation will support staff who report suspicions of fraud or bribery please refer to the CCGs Counter Fraud, Bribery and Corruption Policy and Whistleblowing.

Fraud statement

We have appointed RSM to provide a Local Counter Fraud Specialist (LCFS) to ensure our resources are used for their primary purpose: patient care. Our LCFS investigates alleged fraud, both within and against the CCG, being carried out by or against staff, patients or third parties. The LCFS works with me to ensure we are doing everything possible to prevent and detect fraud and bribery across our organisation. The LCFS is happy to meet with individual staff members; attend team meetings; conduct workshops; and deliver awareness presentations. 

It’s important that we raise awareness of fraud to ensure everyone is aware of it and the harm it can do. You will see various fraud materials throughout the year which should encourage you all to have a conversation about fraud and how we can prevent it. 

As the eyes and ears of the organisation you are our greatest asset in spotting fraud, whether it is being committed by another employee or by an external party.

Simon Goodwin, Chief Finance Officer, North Central London Clinical Commissioning Group

Fair processing notice

We are required by law to protect the public funds we administer. We may share information provided with other bodies responsible for auditing or administering public funds, in order to prevent and detect fraud. The Cabinet Office is responsible for carrying out data matching exercises.

Data matching involves comparing computer records held by one body against other computer records held by the same or another body to determine the extent of the match. This is usually personal information. Computerised data matching allows potentially fraudulent claims and payments to be identified. Where a match is found it may indicate that there is an inconsistency that requires further investigation. No assumption can be made as to whether there is fraud, error, or other explanation until an investigation is carried out.  

We participate in the Cabinet Office’s National Fraud Initiative: a data matching exercise to assist in the prevention and detection of fraud – see guidance here.

The processing of data by the Cabinet Office in a data matching exercise is carried out with statutory authority under its powers in Part 6 of the Local Audit and Accountability Act 2014. It does not require the consent of the individuals concerned under data protection legislation or the General Data Protection Regulation (GDPR).  You can access further information on the reasons why it matches particular information here.

For further information on data matching at the NCL CCG please contact Matt Wilson, Local Counter Fraud Specialist, by emailing matt.wilson2@nhs.net. Further information on how the NFI has assisted the NHS and other public sector organisations can also be found here.