Fraud is a serious crime and costs the NHS billions of pounds every year. In 2012/13 an estimated £4.16 billion was lost nationally to fraud - this equates to a staggering 8000 fully equipped ambulances or 5942 MRI scanners - so fraud is no small matter.
In East and North Hertfordshire CCG we are committed to tackling this issue and want to raise awareness of what fraud is, the issues or risks we might face in the workplace, how we can recognise different forms of fraud and what each of us can do to reduce fraud in the NHS.
Did you know that adding hours to your timesheet, false expense claims, working elsewhere whilst in receipt of sick pay, misrepresentation on job applications or providing false documents to register as a patient or obtain work all constitute fraud?
What is fraud?
Fraud happens when someone does something dishonestly in order to make a gain for themselves or another or cause a loss to another. According to the Fraud Act 2006 it is not necessary to prove a person has been deceived. The focus is on the individual's dishonest behaviour and intent - and just trying to do it, even if not successful, makes the act complete.
S2 False representation - 'To knowingly make a false representation in order to make a gain for himself or another or inflict a loss on another’.
This could be submitting a false timesheet that is not reflective of hours worked, exaggerating travel expenses or claiming for journeys that have never been undertaken or claiming sick leave from the organisation but working a secondary employment.
Patients are equally as able to make a false representation. The Commissioner’s report on economic crime states that 90% of reports involving UK patients relate to prescription misuse and prescription charge evasion.
Case study – ‘Stop smoking advisor jailed for 18 months for fraud’ - A stop smoking advisor claimed £45 for each of the 2017 imaginary ‘successes’ within a six month period in 2006. His ‘success’ rate was deemed so high that he was nominated for a national Stop Smoking Supporter Award. An investigation revealed that many of these 2017 clients had never heard of the advisor. The total amount fraudulently claimed was £90,000.
S3 Failing to disclose information - 'Withholding information that he is under a legal duty to provide, with the dishonest intent that by doing so, he will make a personal gain or cause a loss to another’. This could mean not declaring previous criminal convictions on an application form, failing to report a salary overpayment and keeping the funds for own benefit or failing to disclose and outside interests as they occur, allowing a conflict of interest to arise.
Case study – ‘Project Manager jailed for involvement in armed robbery’ - A Project Manager, on a salary of £250,000, gained his employment with the NHS by failing to disclose that he was currently under investigation for his involvement in an armed robbery. Subsequently, he received 3 months salary payments that he had never been eligible for, based on his criminal record.
S4 Abuse of a position of trust – ‘To dishonestly abuse a position of Trust that he was expected to safeguard, in order to make a gain for himself or another or to inflict a loss on another’. This could include manipulating statistics to achieve a target or creating a post for a family member and bypassing recruitment processes.
Case study – ‘Payroll Manager jailed for 3 years’ - A Payroll Manager abused her position of trust and defrauded the NHS out of £125,000 by putting her family onto the payroll system. Subsequently, she was jailed for 3 years along with four family members who each received six month prison terms.
S6 Possession of articles intended for use in fraud - Example - having a false passport.
What is a bribe?
Bribery is generally defined as giving someone a financial or other advantage to encourage that person to perform their functions or activities improperly or to reward that person for having already done so. It is, therefore, offering an incentive to someone to do something which they wouldn’t normally do. For example, someone offering a job might be offered tickets to an event by one of the candidates or someone linked to them.
Bribery Act 2010
In the context of the Bribery Act 2010, the offence of bribery refers to accepting, as well as offering, a bribe.
The three offences most relevant to the NHS are:
- Section 1 - Offering, promising or giving a bribe to another person to perform a relevant ‘function or activity’ improperly, or to reward a person for the improper performance of such a function or activity.
- Section 2 - Requesting, agreeing to receive or accepting a bribe to perform a function or activity improperly.
- Section 7 - Failure of a commercial organisation to prevent bribery (the corporate offence).
Who can be prosecuted under the Bribery Act 2010?
Any individual associated with an organisation may be liable for a primary bribery offence;A senior management or board member who consented to or connived in a section 1 bribery offence will, together with the organisation, be liable for the section 7 ‘corporate offence’.
- Is it possible someone might be trying to bribe you?
- What questions do you need to ask yourself?
- Have you been offered any gifts or hospitality?
- Is this gift / hospitality reasonable and proportionate?
- What would you regard as reasonable and proportionate?
- Do you believe the gift or hospitality may be an attempt to influence you, because of your position?
- If you are not happy with any of your answers, report your concerns without delay.
What should I do if I suspect fraud or bribery?
If you are suspicious or have concerns:
- DO tell your Local Counter Fraud Specialist (LCFS), Erin Sims. immediately by email or phone (07800 617 456) – your confidentiality will be respected. We never divulge the name of an informant.
- DO keep or copy any document that arouses your suspicions.
- DO NOT confront the individual with your suspicions.
- DO NOT try to investigate your suspicions yourself.
IF YOU WANT you can tell your line manager, but you are not required to - you can come straight to the LCFS.
Our Local Counter Fraud Specialist:
RSM UK Tax and Accounting Limited
The Pinnacle, 170 Midsummer Boulevard, Milton Keynes, Buckinghamshire, MK9 1BP
Alternately, should you wish to raise a concern anomalously, you can report via NHS Protect at www.reportnhsfraud.nhs.uk or via the telephone on 0800 028 4060.
Fraud against the NHS means that the money intended for patient care, and funded by the taxpayer, ends up in the pockets of those who did not legitimately earn it. It means fewer resources are available to be spent on frontline health services such as patient care, health care facilities, doctors, nurses and other staff. NHS Protect is a "Prescribed Person" under the Public Interest Disclosure Act 1998 (PIDA) and exists to tackle fraud (including bribery, corruption or wider economic crime) anywhere it is found in the NHS in England and Wales.
Anyone can use this website to report concerns of fraud within the NHS. Whether you are a member of the public, an NHS employee, a contractor, a supplier, from another government agency or someone else, your input can make a difference.
Don't worry if you don't have all the facts, just detail what you know. By working together we can stop NHS fraud.