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EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES Countering Fraud & Corruption in the NHS MARCH 2011 E-Learning Module NHS NOTTINGHAMSHIRE COUNTY next>>

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1 EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES Countering Fraud & Corruption in the NHS MARCH 2011 E-Learning Module NHS NOTTINGHAMSHIRE COUNTY next>>

2 How this module works Click on the buttons at the bottom right of each screen to navigate through this e- learning module. The buttons represent: Next slide Previous slide Go back to the beginning of the section Go straight to the section questions Press the ESC key on your keyboard to stop the presentation at any time. INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES

3 The aims of this module are:  To explain what constitutes fraud and corruption in the NHS and what you should do if you identify suspicions;  To explain the NHS Counter Fraud Strategy; and  To explain the role of the Local Counter Fraud Specialist (LCFS) and how they can help you and the Trust deal with the problem of fraud. It will take about 20 minutes to complete the whole module. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

4 Why do I need to know about the Counter Fraud Service and go through this module? Any member of staff could potentially become aware of a practice that they think is wrong but they may not know who to talk to about it. This module will give some basic advice on the steps to follow. HOWEVER… please don’t think that fraud is rife in this Trust as the indications are that it is not. This module is intended to promote awareness of the potential for fraud and corruption, so that you know what to do and who to contact if you ever become aware of a suspicion. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

5 Every year millions of pounds of public money are at risk to fraud and corruption in the NHS. A small minority of people feel that it is acceptable, by their criminal behaviour, to deprive the NHS of resources which would otherwise be used to provide patient services. The NHS Counter Fraud Service exists to minimise losses through FRAUD & CORRUPTION EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

6 The NHS Counter Fraud Strategy  The NHS Counter Fraud Service was established in 1998  The Chief Executive and Director of Finance are jointly responsible for ensuring compliance with Secretary of State Directions (or in the case of Foundation Trusts, the Independent Regulator’s License)  Every Health Body in England & Wales must nominate an Accredited Local Counter Fraud Specialist (LCFS) to undertake counter fraud work in 7 generic areas of activity AIM: To reduce fraud within the NHS to an absolute minimum and hold it permanently at that level to free up resources for better patient care EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

7 Secretary of State NHS Business Service Authority NHS Protect Area Counter Fraud Specialist Director of Finance/Chief Executive Local Counter Fraud Specialist Trust employees, patients, visitors and contractors The Counter Fraud Structure EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

8 Review Your Learning What have you learnt from this module so far? Here are a few questions… EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

9 The Trust’s Audit Committee because they are worried about the level of fraud at this Trust. The Secretary of State so that mechanisms can be established to reduce NHS fraud nationally. Who set up the NHS Counter Fraud Service? Choose your answer EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

10 The Secretary of State directions issued in 1999 set in motion the NHS Counter Fraud Initiative that all health bodies must adhere to. Who set up the NHS Counter Fraud Service? The Secretary of State so that mechanisms can be established to reduce NHS Fraud nationally. Yes, that’s right! EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

11 Every health body has to comply with Secretary of State Directions or in the case of Foundation Trusts, the Independent Regulators License requirements. Compliance with the directions in no way implies that fraud is rife at the Trust or that the Audit Committee and the Director of Finance are concerned that fraud is a particular problem within the organisation.  Who set up the NHS Counter Fraud Service? The Trust’s Audit Committee because they are worried about the level of fraud at this Trust. No, that’s the wrong answer, please try again EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

12 The Local Counter Fraud Specialist The Director of Finance & Chief Executive Who is responsible for ensuring the directions are followed at this Trust? Choose your answer The Secretary of State through NHS Protect EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

13 The Local Counter Fraud Specialist carries out work to assist the Trust’s compliance with Secretary of State Directions/the Independent Regulators License requirements. NHS Protect undertakes assessments of the adequacy of compliance with directions within the Trust.  Who is responsible for ensuring the directions are followed at this Trust? No, that’s the wrong answer, please try again EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

14 Who is responsible for ensuring the directions are followed at this Trust? The Director of Finance and Chief Executive are responsible for monitoring compliance with Secretary of State Directions/the Independent Regulators License requirements but will be guided by reports received from the Local Counter Fraud Specialist and NHS Protect. The Director of Finance & Chief Executive. Yes, that’s right! EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

15 Between 1999 and 2010: Nationally… Is the Counter Fraud Service effective?  More than £65 million was recovered;  Approximately £824 million was saved; and  There were 616 successful prosecutions. In alone:  £4,182,758 in potential savings were identified;  2626 investigations were concluded;  there were 150 successful prosecutions; and  583 civil and disciplinary sanctions were applied. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

16 During the 2 year period ending 31 st March 2010, East Midlands NHS Local Counter Fraud Services: Is the Counter Fraud Service effective?  Received 268 referrals  Brought 236 investigations to conclusion  Identified 107 system weaknesses  Obtained 21 criminal convictions, 54 disciplinary sanctions and 12 awards by civil action  Identified fraud losses totalling £1.24m (£1m recoverable)  Brought the Counter Fraud message to almost 24,000 NHS staff EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

17 Review Your Learning What have you learnt from this module so far? Here are a few questions… EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

18 £3 million has been recovered to date. £15 million has been recovered to date. How much money, diverted from the NHS through Fraud, has already been recovered and put back into patient care? Choose your answer £65 million has been recovered to date. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

19 How much money, diverted from the NHS through Fraud, has already been recovered and put back into patient care?  No, that’s the wrong answer, please try again EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

20 How much money, diverted from the NHS through Fraud, has already been recovered and put back into patient care? Over £65 million has been recovered to date, but this amount is increasing as new cases are being investigated. Yes, that’s right! EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

21 In the simplest of terms, Fraud is theft with an element of deception involved. The most common offences under the Fraud Act 2006 are: Fraud by false representation – e.g. submission of false timesheets for shifts not worked Fraud by failing to disclose – e.g. failing to declare criminal convictions when applying for NHS employment Fraud by abuse of position – e.g. a person in a position of trust using their position to commit fraud (Some fraud offences, committed before 15 th January 2007, continue to be prosecuted under the Theft Acts) What is Fraud? EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

22 Corruption is defined as the offering, giving, soliciting or acceptance of inducements which may influence a person’s actions. For example a supplier making a payment to a staff member to secure a contract or to supply goods or services in excess of actual requirements. The Trust may, as a result, fail to achieve value for money or pay for goods not required. What is Corruption? EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

23 Examples of potential Fraud & Corruption in the NHS  Submission of false timesheets for shifts not worked;  Employees claiming NHS sick pay when actually working for another employer;  False declarations of employment history/qualifications in order to gain employment;  Submission of false/excessive expense claims;  Submission of false quotes, invoices or receipts in order to obtain financial reimbursement (staff & suppliers/contractors);  Contractors claiming for goods/services not supplied; EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

24 Examples of potential Fraud & Corruption in the NHS  Diversion of charitable donations for personal benefit;  Failing to report receipt of salary (or other) overpayment;  Employees conducting personal/private business in work time;  Unauthorised use of NHS equipment /facilities for personal gain;  Acceptance of gifts and inducements for third party advantage;  Patients falsely claiming entitlement to NHS treatment/services;  Patients falsely claiming exemption from NHS charges. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

25 Who might commit Fraud?  Staff  Patients  Contractors  Suppliers  Visitors Anyone EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

26 Review Your Learning What have you learnt from this module so far? Here are a few questions… EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

27 Yes, I do. No, I have no involvement in this. Do you, as a Trust employee, have a part to play in countering NHS Fraud? Choose your answer EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

28 Regardless of your job role, you may come across fraud in the course of your normal duties. If you do, your responsibilities are outlined in the Trust’s Fraud and Corruption Policy. You must report any suspected fraud to the Local Counter Fraud Specialist so that an investigation can take place. Failure to do this could result in the fraud remaining undetected and money continuing to be fraudulently diverted from patient care. Do you, as a Trust employee, have a part to play in countering NHS Fraud?  No, that’s the wrong answer, please try again EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

29 As a Trust employee, if you think someone is acting fraudulently, then you must report this to the Local Counter Fraud Specialist, in accordance with the Trust Fraud and Corruption Policy. Do you, as a Trust employee, have a part to play in countering NHS Fraud? Yes, that’s right! EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

30 Staff adding shifts or hours to a timesheet that they know have not been worked. Staff retaining a payment with their salary that they know they are not entitled to. Which of the following scenarios could be considered fraudulent? Choose your answer Staff working elsewhere while claiming NHS sick pay. All of the above. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

31 All the options listed are potential frauds. Which of the following scenarios could be considered fraudulent? Yes, that’s right! EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

32 The answer you chose is a potential fraud, but so are the other three. The correct answer is, therefore, all of the above. Yes, that’s right, but … Which of the following scenarios could be considered fraudulent? EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

33 Do make a note of your suspicions. Sign the note, date it and keep it safe. Do try to secure or copy documents you believe to be suspicious. Do contact your LCFS on (Further reporting methods can be found on the Trust’s Counter Fraud intranet page). Don’t investigate the matter yourself or report it to your manager – this may compromise any potential prosecution. Don’t undertake any surveillance – this will breach the Human Rights Act. What do I do if I think a Fraud is occurring? EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES   INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

34 What if I am wrong?  Never be afraid to raise your suspicions directly with your Local Counter Fraud Specialist even though you may be wrong…You could be right!  There will be no ramifications for raising an issue you believe to be fraud, regardless of how the investigation is concluded, as long as your referral was raised in good faith.  If you are uncertain of whether a referral is needed, you should contact your Local Counter Fraud Specialist anyway for advice.  The person investigated will not be disadvantaged if the investigation undertaken does not uncover any fraudulent activity. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

35 What if I am right?  The LCFS will have validated the suspicions and uncovered evidence.  The person under investigation will have explained their actions at a formal interview under caution. (Whatever is said can be used in a criminal prosecution).  A decision will be reached regarding appropriate sanctions to be pursued.  Any loss will be calculated and a decision will be made regarding appropriate recovery action. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

36    C/O Internal Audit, Laurie House, Colyear Street, Derby, DE1 1LJ Your LCFS is Penny Gee How do I contact my Local Counter Fraud Specialist?  You may also call the National NHS Fraud and Corruption Reporting Line (open 8am – 6pm, freephone ) or report on-line at EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

37 Yes, and anonymous referrals will be investigated, however it may hinder any investigation if we are unable to contact you in case we need further information. Even if you only give a contact reference and telephone number, this may help with the investigation as initial enquiries might prove inconclusive and we may therefore need to come back to you to see if you have any further information which might help us progress the investigation fully. If you do give us minimal contact details these will not be used to identify you. Can I report my suspicions anonymously? EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

38 This person is specially trained to: What is a Local Counter Fraud Specialist?  Promote fraud awareness within the Trust;  Prevent and detect fraud;  Conduct professional fraud investigations;  Answer concerns and queries; and  Liaise with the Director of Finance and NHS Protect EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

39 The Role of the LCFS  The creation of an Anti-Fraud culture;  Maximum Deterrence of Fraud;  Successful Prevention of Fraud which cannot be deterred;  Prompt Detection of Fraud which cannot be prevented;  Professional Investigation of detected Fraud;  Ensuring effective Sanctions are applied against those who commit Fraud;  Ensuring effective Redress is sought where financial losses are identified. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

40 Can anyone investigate Fraud? (such as a line manager or a Human Resources Officer) NO The Secretary of State Directions on NHS fraud clearly state that only a nominated and accredited Local Counter Fraud Specialist can undertake fraud investigations for each Health Body. This is to ensure that legislation governing criminal investigations (including the Human Rights Act and Data Protection Act) is not breached and as a consequence, that any potential criminal prosecution is not compromised. However… The LCFS works very closely with Human Resources whenever a member of staff is under investigation. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

41 There are three courses of action that would be considered where fraud has been identified. Any one, or a combination of, these could be used: What sanctions might be applied to people who commit Fraud?  Criminal prosecution or a Police caution (resulting in a criminal record);  Civil proceedings (including County Court orders) to recover financial losses;  Disciplinary proceedings (including action taken by a professional body). EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

42 This will generally be a decision made jointly by the LCFS, Director of Finance, Area Counter Fraud Specialist and the Director of NHS Protect, taking account of legal advice. Serious cases involving employees may be pursued via both criminal and civil investigations, which may also result in internal and external disciplinary action. Where financial losses to the NHS are identified during the course of an investigation, recommendations are made by the LCFS to ensure that financial redress may be obtained from the offender. Who decides which sanction, or sanctions, are to be used? EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

43 Review Your Learning What have you learnt from this module so far? Here are a few questions… EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

44 Line Manager / Directorate Manager Director of Finance or Finance staff Who can investigate a potential fraud within this Trust? Choose your answer Director of Human Resources or Human Resources staff Local Counter Fraud Specialist EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

45 Only the Local Counter Fraud Specialist can investigate any potential fraud within the Trust.  No, that’s the wrong answer, please try again Who can investigate a potential fraud within this Trust? EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

46 Who can investigate a potential fraud within this Trust? If any other staff investigate fraud, it would be contrary to the Secretary of State Directions and could compromise any criminal proceedings that the Trust may wish to take once fraud has been proven. Cases must be referred directly to the Local Counter Fraud Specialist (not via line management). Yes, that’s right! EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

47 You go out of your way to watch the person to catch them in the act. You then confront them with the evidence. You make an immediate note of everything you’ve seen and then contact the Local Counter Fraud Specialist. You have evidence of Fraud. What do you do? Choose your answer EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

48 You have evidence of Fraud. What do you do? By going out of your way to watch someone you may be contravening the Human Rights Act and/or the Regulation of Investigatory Powers Act This could compromise any subsequent criminal case. Also an action could be brought against the Trust as a consequence of a member of its staff acting in this manner.  No, that’s the wrong answer, please try again EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

49 You have evidence of Fraud. What do you do? Make a detailed note, sign and date it, then contact your Local Counter Fraud Specialist for advice on Yes, that’s right! EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

50 Don’t tell anyone because you could be wrong. Contact your Local Counter Fraud Specialist and ask for advice. You think you know of a Fraud being carried out but you have no evidence. What do you do? Choose your answer Make it known to the person you are concerned about that you know what they are doing. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

51 You think you know of a Fraud being carried out but you have no evidence. What do you do? By not doing anything you are allowing a possible fraud to continue and more and more money may be diverted from patient care. By telling the person that you know about the fraud, evidence could be destroyed and the fraud could continue (by some other means), allowing monies to continue to be diverted from patient care.  No, that’s the wrong answer, please try again EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

52 You think you know of a Fraud being carried out but you have no evidence. What do you do? If you are in any doubt or worried about what might be occurring, then contact your Local Counter Fraud Specialist, Penny Gee, for advice on Yes, that’s right! EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

53 You have now completed this training module and are better informed about NHS fraud. (See the following slide for details of how you can obtain a certificate for your personal development portfolio). Fraud against the NHS diverts resources (tax payers money) from the provision of the best quality patient care, the core business of the NHS. Please help us stamp out all fraud and corruption in the NHS and report any suspicions of fraud to your Local Counter Fraud Specialist. Well done! EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

54 If you have any queries regarding the content of this e-Learning module, need further advice, or wish to report a fraud, please contact Penny Gee, your LCFS, on You may also call the National NHS Fraud and Corruption Reporting Line (open 8am – 6pm, freephone ) or report on-line at Don’t forget to (quoting code 1104GELM in the subject line) to confirm completion of this e- Learning module and request a certificate for your personal development portfolio. Your certificate will be returned to you by EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

55 Remember Everyone working in the NHS has a responsibility to prevent and detect fraud and report concerns of fraud or corruption to your Local Counter Fraud Specialist. You may now press Esc to exit this module… alternatively, the following slides provide details of just a small selection of the many cases successfully investigated by East Midlands NHS Local Counter Fraud Services. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

56 Bereavement Advisor Imprisoned for 5 Years for £753,000 Fraud A former NHS Bereavement Advisor from Leicestershire was jailed for 5 years on 30 April 2010 for obtaining £753,000 from deceased patients’ estates by making fraudulent applications to Leicester Registry Office, forging letters of authority from supposed distant relatives and suggesting to grieving families that she could relieve them of the burden of obtaining Grant of Probate. In mitigation, the defendant said that she thought of herself as a “modern day Robin Hood”, arguing that the money she took would have gone to the state whilst she had better uses for it. She claimed that she had given money to the needy, including prostitutes, refugees and asylum seekers. She also admitted, however, maintaining a lifestyle she could not otherwise have afforded, including the purchase of flats, a narrowboat and high performance cars paid for in cash. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

57 Doctor Struck-Off for £2450 Expenses Fraud A former Derbyshire hospital Doctor was struck-off by the General Medical Council (GMC) in August 2010 after falsely claiming £2,450 for relocation and removal expenses from her former NHS employer. The Doctor submitted an expenses claim relating to her move from London after starting work in Derby in Staff at the hospital were suspicious of the claim, which was referred to the Local Counter Fraud Specialist (LCFS) and payment refused. The LCFS investigation identified the claim to be false as the removals company the Doctor claimed to have paid did not actually exist. The Doctor was dismissed from the hospital and she and her husband were subsequently issued with Police cautions after they admitted falsifying the claim and supporting evidence. The GMC panel described the Doctor’s actions as, “a pre-planned act of deception for her own financial gain” and found that the receipt of a Police caution was, “a serious breach of the standards expected of a Doctor”. The panel therefore concluded that her fitness to practice was impaired and she was struck off the professional register. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

58 Former Head of Orthotics Convicted for £21k Fraud A former Head of Orthotics who defrauded the NHS of over £21k received a suspended 12-month prison sentence in 2010 and was ordered to complete 150 hours’ unpaid work. He was also ordered to sell assets in order to compensate his former NHS employer for their losses. The defendant was Principal Orthotist at a Nottinghamshire hospital, in charge of the workshop where medical devices are made. He was permitted to use the workshop for private clients provided he paid for this and NHS patients weren’t affected but he didn’t pay for hundreds of devices, costing the NHS £28k. The investigation also found that the subject earned over £5,000 as a University Lecturer for work carried out in NHS time and that he also marketed the supplies company he co-directed. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

59 Caution Order Imposed on Agency Worker for Timesheet Fraud In July 2010 an agency worker who admitted to submitting false timesheets to his agency for work that he did not complete while assigned to a Leicestershire hospital had a caution order placed against his Health Professionals Council (HPC) registration. The worker admitted to submitting false timesheets over a three month period with a value of £3600 which was subsequently recovered by the Hospital Trust. In reaching their decision the HPC determined that the worker had brought the reputation of his profession into disrepute. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

60 Nottingham Practice Manager Sentenced for NHS Fraud and Theft A former GP Practice Manager from Nottingham was given a 51-week suspended sentence, a 12-month supervision order and a six-month curfew at Derby Crown Court after charging personal goods to the NHS, and falsifying overtime and petty cash claims valued at up to £28,000. She had been employed by Derbyshire County PCT as a GP Practice Manager for two years but resigned in November 2007 amidst an investigation by the NHS Local Counter Fraud Specialist (LCFS) and the Derbyshire Police. The investigation commenced after the subject’s manager discovered some suspicious invoices whilst she was away sick. It was discovered that she had used the trust’s account to purchase over £6,000 worth of electronic goods, including LCD televisions and an expensive stereo system, which were delivered to her home address. A search of the Practice Manager’s locked desk then revealed copies of false overtime claims for which she had been paid more than £16,000. Suspicious petty cash requests in excess of £5,000 were also identified during the search, with monthly claims increasing from £150 to £900. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

61 Arrest Warrant Issued for Suspected Fraudster An arrest warrant has been issued for an NHS employee who left the country after an alleged sick pay fraud totalling almost £8,000. An LCFS investigation identified that the subject had reported sick to their substantive Derbyshire NHS employer in order to work bank shifts for another NHS Trust. The resulting false claims for sick pay totalled £7,791. At a formal interview with the LCFS, the subject admitted carrying out the fraud and subsequently resigned from their post. Following the interview a file was submitted to prosecuting Solicitors but the subject failed to attend a scheduled Court hearing and a warrant was issued for her arrest. Information was later received indicating that the subject had left the country shortly after the Court hearing date. The arrest warrant remains outstanding and the matter has been reported to the High Commission for the subject’s new country of residence. Should the subject return to the UK, she will be arrested and brought before the Court to answer the charges against her. In the meantime, attempts are continuing with a view to recovering the £7,791 in defrauded NHS funds. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

62 Nottingham Pay Officer Convicted for NHS Fraud A pay officer from Nottingham was sentenced to two years conditional discharge and ordered to pay £250 in costs at Nottingham Crown Court after defrauding the NHS of more than £3000. She was charged with two counts of false accounting after admitting she transferred £3332 that she was not entitled to from the Trust’s payroll system into her bank account in EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT

63 Derbyshire Health Care Assistant Jailed for Timesheet Fraud A Healthcare Assistant was jailed for 15 months in December 2005 for cheating the NHS out of £50k. Between June 2002 and October 2004 he had submitted timesheets to the ETI nursing agency for work he never undertook. The fraud was discovered when staff at the Trust noticed his name on an invoice and were surprised, considering he had not worked there for 2 years! The suspicions were referred to the East Midlands Regional Team of the NHS Counter Fraud Service. Hospital duty rosters and interviews with staff confirmed that he had not worked any of the shifts he claimed for. Including agency fees, the total loss to the Trust ran to £80k Including agency fees, the total loss to the Trust ran to £80k. Press Esc to exit this module. EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDITCONSULTANCYIT AUDIT & FORENSICSPOST PAYMENT VERIFICATION COUNTER FRAUDSECURITY MANAGEMENT


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