Presentation on theme: "2006£13bn Estimate based on sources available in the public domain 2010£30bn Annual Fraud Indicator 2011£38bn Annual Fraud Indicator 2012£73bn Annual Fraud."— Presentation transcript:
2006£13bn Estimate based on sources available in the public domain 2010£30bn Annual Fraud Indicator 2011£38bn Annual Fraud Indicator 2012£73bn Annual Fraud Indicator Christopher Hooper What is fraud? Examples of fraud Fraud prosecutions Bribery Act Fraud risks “Do’s & don’ts” Reporting your concerns Useful documents & links Total Fraud in the UK These figures relate to all fraud in the UK not just NHS Counter Fraud Service: Information for CCG Staff Introduction Welcome to the Counter Fraud intranet pages. These pages have been designed to help make staff at Waltham Forest Commissioning Group (CCG) aware of what fraud and bribery are, to provide examples of the types of fraud that can occur within the NHS and provide information as to what action should be taken should a suspicion of fraud, bribery or corruption arise. 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. The role of NHS Protect 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. Baker Tilly Fraud Risk Services currently provides your Local Counter Fraud Specialist (LCFS) and the role of the LCFS is to implement the NHS Counter Fraud strategy 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. Counter Fraud Service: Information for CCG Staff Introduction Welcome to the Counter Fraud intranet pages. These pages have been designed to help make staff at Waltham Forest Commissioning Group (CCG) aware of what fraud and bribery are, to provide examples of the types of fraud that can occur within the NHS and provide information as to what action should be taken should a suspicion of fraud, bribery or corruption arise. 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. The role of NHS Protect 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. Baker Tilly Fraud Risk Services currently provides your Local Counter Fraud Specialist (LCFS) and the role of the LCFS is to implement the NHS Counter Fraud strategy 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. Chaya-Orna Diamond
What is Fraud? The main offences of fraud are currently contained within the Fraud Act 2006, which was implemented on 15 January 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. Fraud Act 2006 False representation Failure to discloseAbuse of Position
Examples of Fraud Professionals Alteration of records; false claims for work; creation of ‘ghost patients’; private work on NHS time; working elsewhere during contracted hours and fraudulent claims for out-of-hours visits. Example: A Dentist was sentenced to two years’ imprisonment for creating fictitious patients on his dental register and fraudulently claiming money for treating them on the NHS. The subject pleaded guilty to fraud and theft totalling £109,000. He submitted false claims to NHS Dental Services and deceived NHS patients into being treated and charged privately. Managers and Staff Submission of false timesheets; working elsewhere whilst on sick leave; submission of false expense claims; providing false information on a CV or application form; failing to disclose criminal convictions; producing false qualification certificates; producing false identity or Home Office documents to obtain employment; knowingly authorising false timesheets or expense claims; payroll fraud. Example: A healthcare support worker who committed fraud amounting to over £60,000 was sentenced to 21 months imprisonment. She submitted entirely false bank timesheets for two years after working only a handful of shifts. In total she was charged with 26 counts of fraud with 68 further offences taken into consideration. Patients Falsely claiming exemption for prescriptions; falsely obtaining NHS services free of charge and submission of false patient travel claims. Example: The parents of a child that was a patient at a hospital submitted false travel claims to the Cashiers Office for reimbursement. Each parent was sentenced to imprisonment for fraud. Please note these are only examples and do not exclusively represent all types of fraud offences.
“GP FALSIFIES 1,700 PATIENT RECORDS SENTENCED FOR £62K NHS FRAUD” A GP from Greater Manchester a NHS Primary Care Trust of £62k. Between the dates March 2008, he manipulated the doctors system 7000 times to hit targets and increase payments to his practice. He falsely claimed for patient checks he hadn’t undertaken including digital retinopathy checks, which can prevent diabetic patients from going blind. The unusual pattern of outputs from the surgery alerted the LCFS to conduct an investigation. The doctor was suspended from the GP practice he worked in and has been referred to the General Medical Council. He was sentenced to nine months imprisonment which was suspended for 18 months and ordered to repay £50,000. “COUPLE DECEIVE NHS TO CLAIM SICK PAY AND PROVIDES FORGED APPLICATION FORMS” Two people from Southampton completed each other’s application forms by forging medical qualifications to gain employment within the NHS. One of them took sick leave within two days of starting work a NHS Hospital for nearly three months for ‘stress and anxiety’ claiming nearly £2,300 in wages. She applied for a new job at a different NHS Trust whilst on sick from the NHS Hospital and even started employment there whilst still on sick leave. The same individual went on to take sick leave within days of commencing employment at the other NHS Trust. The fraud was uncovered as she applied for a further two more jobs whilst on sick leave as her application appeared unusual. She was given an eight month prison sentence which was suspended for eight months and an additional 100 hours unpaid work. “GP PRACTICE MANAGER COMMITS £150,000 FRAUD AGAINST THE NHS” A GP practice manager defrauded her employer out of £150,000. She created false invoices to drug suppliers and for the supply of goods and services to the practice. She had also inflated her salary by creating false overtime payments and at the peak of her offending she was diverting up to £3,000 a week from practice funds into her own bank account. Her fraudulent behaviour was uncovered as her colleagues began to notice financial irregularities at the practice and an investigation was launched. She was sentenced to 18 months imprisonment for seven different fraud offences. “MAN FAILS TO REPORT OVERPAYMENT FROM THE NHS RESULTING IN PRISON SENTENCE” A GP who worked as an out of hours call handler for the NHS left his job in November 2008 and incorrectly continued to receive payment of a full salary until August He was paid an incorrect overpayment of £31,205 during this time. It was spotted that he was receiving an overpayment when the National Fraud Initiative system, monitored by the LCFS, noticed that the individual was a full time employee at both a NHS ambulance service and a healthboard. It was found that he was receiving the overpayment from his previous employer due to an administrative error; however he was still liable for the offence as he did not report or try to prevent the payments. He was sentenced to six months imprisonment which was suspended for 18 months and 200 hours of unpaid work. He has also agreed that in order to repay the funds he has signed over £31,205 out of his NHS pension to cover the loss. Recent Fraud Prosecutions in the NHS
Bribery Act 2010 Offering, promising or giving a bribe Requesting or agreeing to receive a bribe Bribing a foreign public official Failure to prevent bribery. Bribery Act 2010 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. There are offences for individuals, a corporate offence for corporates and partnerships and penalties for non-compliance are serious. 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. How does this affect you? There are six adequate procedures to which the CCG is responsible for adopting. All staff should be aware of the organisation’s Anti- Fraud and Anti- Bribery Policy and you should take your time to familiarise yourself with its content. In conjunction with this, staff should have an awareness of the other related policies identified within the Anti-Bribery Policy, such as the Anti-Fraud, Gifts & Hospitality, Whistleblowing and Gifts and Hospitality and Declaration of Interest Policy policies. Staff could be held individually accountable for acting against these policies or the Act itself. This could lead to disciplinary and/or criminal investigation. The LCFS has drafted two ‘Key Points Guidance’ documents. The guidance has been drafted and issued to act as a quick guide for staff and key risk departments such as Finance, Estates and Procurement. The documents provide further information about the Bribery Act Please click on the relevant link to find out more about the Bribery Act and the Fraud Act and how it affects you and your team.
Fraud Risks Below are examples of some recent national fraud risks which staff at the CCG should be aware of: Cybercrime The National Crime Agency have advised computer users about two pieces of malware software known as GOZeuS and CryptoLocker which infect computers through attachments or links in s. Computer users (personal and businesses) should take action to protect their computers from these associated forms of malware. Advice, guidance and tools can be found on the Get Safe Online website.website Source: National Crime Agency Android ‘Police’ Malware This type of malware is designed to prevent the user from accessing the home screen as well as other application on the Android device. The malware achieves this by disabling the back space button. If a device has been infected, a pop up appears on the screen displaying a warning message, which claims to come from the police or other anti- crime agencies. The pop up states that the device been locked, and can only be unlocked on payment of a fine. The fine should not be paid, as it is unlikely to resolve the issue. The National Fraud Intelligence Bureau and Action Fraud websites provide advice as to how to remove the malware from android devices. More information can be found on the action fraud website here.here Source – Action Fraud Contracts for display screens and advertising cards Sales representatives of companies have approached staff at NHS hospitals and have persuaded staff members to enter into agreements on behalf of NHS bodies purportedly allowing the companies to install display screens and/or appointment cards in the hospital. In some cases, agreements for up to 8 years in duration have been entered into, with no provisions for the NHS bodies to terminate the contract. Some of the contracts do not place any restriction on the content or type of advertising which has led to inappropriate advertising content being displayed. In some cases, substantial financial claims have been brought against NHS bodies which have declined to display advertising, or have switched off display screens as a consequence of the inappropriate content. Please note these are only examples and do not exclusively represent all fraud risks.
What should you do? DODON’T Report your concerns to either the LCFS, Interim Director of Finance, Deputy Director – Corporate Finance (amend titles to reflect client) or NHS Fraud and Corruption Reporting Line as soon as possible. Any delay may cause the organisation to suffer further loss. Confront the individual directly. Make a note of your concerns.Try to investigate the matter yourself. Note all relevant details - what was said; significant dates; times and names of all parties involved. Contact the police directly. Undertake your own surveillance If possible, retain copies of relevant documentation i.e. anything that aroused your suspicion and supports your allegation. Convey your suspicions to anyone with the appropriate authority to investigate Do Nothing! LCFS referral form Christopher Hooper Chaya-Orna Diamond
Reporting Your Concerns Should you have a concern or suspicion relating to fraud, corruption or bribery within the CCG, or need advice, then you can contact the CCG’s Local Counter Fraud Team using the contact details provided. Alternative methods of reporting include: Les Borrett Chief Finance Officer NHS Fraud and Corruption Reporting Line on or on 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 Public Concern at Work (PCaW). PCaW is a registered charity that provides advice on whistleblowing and can be contacted on If in Doubt, Raise it! If you are unsure about your suspicions or concerns please talk to Counter Fraud Team as soon as possible. We will be able to provide you with appropriate advice and guidance with any issues relating to fraud, bribery or corruption. It is important to remember that your concerns maybe important to prevent ongoing fraud being committed against the organisation and stop funds being diverted away from patient care. Confidentiality The Counter Fraud Team and the CCG is 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 at Court; however we will seek you 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 Policy, Whistleblowing Policy.
Useful Documents and links LCFS Guidance Notes provide information and guidance on fraud risk areas that are having an impact on the NHS. The Guidance Notes provide information on the measures that the organisation and staff should be adopting to minimise the risk of fraud occurring at the organisation