Counter Fraud


Fraud and bribery within the NHS is not acceptable as these offences divert valuable resources away from patient care and put patients at risk. It is important that funds which are intended for healthcare are used as such; therefore the CCG takes a zero tolerance approach towards 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 CFA Organisational strategy 2017-2020 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 however, there is a small minority against which action has to be taken to reduce fraud to an absolute minimum.

Local Counter Fraud Specialists:

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

Kate Harrington Stillwell
Tel: 07778 862 713
E-mail: kate.harrington-stillwell@nhs.net

The main offences of fraud are currently contained within the Fraud Act 2006, which was implemented on 15 January 2007. Fraud is any deliberate intent to dishonestly deprive someone, or somebody (i.e. the NHS) of money, goods or services through false representation (can be written, verbal or implied). For an offence of fraud to be committed, the perpetrator must have dishonest intent, and must intend to make a gain, cause a loss, or expose another to the risk of a loss.

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

Example: An individual lying of 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 have made a gain for themselves. 

  • 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: An employee creates patient records on the patient booking system for a family member who lives abroad to enable them to access NHS services free of charge.

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

Prescription fraud

  • A CCG undertook a fraud investigation into a long standing and trusted member of the reception team at a GP Practice, who abused her position by taking advantage of poor IT policy procedures and adherence to those procedures.
  • The member of staff raised false prescriptions on elderly patients’ records who were in receipt of repeat prescriptions.
  • They then supplied the fraudulent prescriptions to unknown third parties, who then presented them at out of area pharmacies.
  • They were sentenced to 12 months Conditional Discharge and ordered to pay costs of £235 and compensation of £400.

Doctor falsifying records

  • A doctor who stole over £62,000 from the NHS was sentenced to 9 months’ imprisonment (suspended for 18 months) and must pay £50,000 costs.
  • He admitted to falsifying the records of 1,703 patients to hit targets and increase payments from the NHS to his practice, and pleaded guilty to two offences under the Fraud Act.
  • In just three days he manipulated the practice’s patient records system over 7,000 times in order to hit financial targets. He falsely claimed for patient checks he had not carried out

The Bribery Act reforms the criminal law to provide a new, modern and comprehensive scheme of bribery offences that will 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 EU contract tenders
  • Reputation is ruined by allegations of bribery and corruption.

Do:

  • Report your concerns to either the counter fraud team, Chief Finance Officer or NHS Fraud and corruption reporting line as soon as possible. Any delay may cause the organisation to suffer further loss
  • 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!

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

Kate Harrington Stillwell
Tel: 07778 862 713
E-mail: kate.harrington-stillwell@nhs.net

 

Alternative methods of reporting include:

  • Emailing or speaking to Simon Goodwin, North Central London CCG’s Chief Finance Officer
  • File a report via NHS Counter Fraud Authority's website or call its corruption reporting line on 0800 028 40 60 

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 email Public Concern at Work (PCaW) or call them on 020 7404 6609. PCaW is a registered charity that provides employees with advice on whistleblowing.

The counter fraud team and Islington 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 organisation’s Anti-Fraud and Bribery Policy and Whistleblowing.

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 CCGs, 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 Groups

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 which 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).  For further information on the reasons why it matches particular information, click here. 

For further information on data matching at the NCL CCG please contact Kate Harrington Stillwell Local Counter Fraud Specialist, by emailing kate.harrington-stillwell@rsmuk.com.  Further information on how the NFI has assisted the NHS and other public sector organisations can also be found here.