1. Not Protectively Marked – Public Document
Fraud in Social Care
Attacking the Weak
David Kleinberg
Assistant Director – Head of the CFID

2. Who are we? National function, hosted at Thurrock Council in Essex
2014/15 DCLG Grant Funding
Multi-Agency collaboration
Understanding the threat
Disrupt and pursue criminality targeting frontline services
25 public bodies supported in crime reduction activity

3. Local government landscape
£2.1bn Annual Loss (2013)
1,795 Investigators (2014)
104,000 detections of fraud (2014)
£2.1bn Annual Loss (2016)
266 Investigators (2017)
75,000 detections of fraud (2017)

4. Local Government Fraud
Local government landscape
Local Government Fraud
Welfare Benefit Fraud
£1.1bn
£2.1bn

5. Local government landscape
DWP SFIS
Local Government
3,600
897
£1.1bn
£2.1bn

6. Economic Crime in Local Government
Appendix 5
Cyber Crime
£3bn
Procurement
Fraud
£4.4bn
Social Care
Fraud
£800m
Cyber Crime
£1.8bn
Revenue Fraud
£1bn
Money Laundering
£1bn
Housing
Fraud
£1.8bn
Insider Threat
£1bn
Transport
Fraud
£48m
Economic Crime in Local Government
Insurance
Fraud
£555m
Grants
Fraud
£94m
£12.9bn
The
Threats
annually
Cost local government
Two of these three threats are seen as ‘emerging’
Large amount of the assessment is the maturity of the control framework and ethical conflicts between social care & financial governance
Crucially – money laundering is the largest risk area

7. Economic Crime in Local Government
Appendix 5
Cyber Crime
£3bn
Procurement
Fraud
£4.4bn
Social Care
Fraud
£800m
Cyber Crime
£1.8bn
Revenue Fraud
£1bn
Money Laundering
£1bn
Housing
Fraud
£1.8bn
Insider Threat
£1bn
Transport
Fraud
£48m
Economic Crime in Local Government
Insurance
Fraud
£555m
Grants
Fraud
£94m
£12.9bn
The
Threats
annually
Cost local government
Two of these three threats are seen as ‘emerging’
Large amount of the assessment is the maturity of the control framework and ethical conflicts between social care & financial governance
Crucially – money laundering is the largest risk area

8. Counter Fraud Dishonest behaviour to: Make a loss; OR Cause a loss; OR
Fraud & the Law
What is it?
Dishonest behaviour to:
Make a loss; OR
Cause a loss; OR
Cause a risk of loss to another
BUT
No gain or loss needs to actually to have been made
Counter Fraud

9. What is dishonest behaviour?
Appendix 5
Fraud & the Law
What is dishonest behaviour?
False representations
Untrue or misleading comments
Failing to disclose information
A Legal duty to disclose something (something that utmost good faith is expected)
e.g. failing to disclose capital, shares, property,
Counter Fraud
So we must prosecute every time then?....

10. Counter Fraud Procurement Fraud Risk Profile
£4.4bn
Legitimate suppliers adding unauthorised costs to invoices
Legitimate suppliers conspiring with staff to add costs to invoices
Fraudulent suppliers/staff submitting completely false invoices
Fraudulent diversion of payments to suppliers to another bank account
Suppliers intentionally providing poor quality goods or services
Criminals diverting legitimate payments for suppliers to their own accounts
Counter Fraud

11. Counter Fraud Social Care Fraud Risk Profile
£800m
Around £17bn spent every year on adult social care
A person falsely presents their social care needs
A person intentionally withholds their true financial status
A person does not use care monies for what it was paid for
A carer abuses their position by not delivering the care they are paid for
A carer steals from a person or submits false claims for work
An adult or child is financially abused by a person, stealing or depriving them of their/ or family assets
Counter Fraud

12. Countering Fraud with Controls
Social Care Fraud
Countering Fraud with Controls
Social Care
Fraud
£800m
Adult ‘ongoing duty’ to declare changes
Sharing (with consent) agreed packages with providers
Front-end intelligence from Social Workers making assessments
Auditing of packages agreed and finances
‘Front-ended’ Controls / Lack on-going Back-office compliance
Eyes & Ears – reporting back on reviews…. Analysis
Financial abuse – knowing your ‘customer’ is a third party required? Who did the worker deal with? MCA?
Counter Fraud

13. Counter Fraud Money Laundering Risk Profile
Criminals paying for legitimate debts on behalf of another individual, with illegal proceeds
Use of ‘tainted gifts’ from crime proposed as assets
Third parties paying care costs
Deprivation of assets
Abuse of an adults account for laundering
Counter Fraud

14. Our Strategy
Prevent
Stop individuals becoming involved in fraud or providing support for economic crime activity
Protect
Create the conditions in which crime prevention against fraud, particularly cyber enabled, mirrors the best aspects of physical crime prevention
Prepare
Use intelligence to change perceptions and create effective actions against the threats across the council and in its supply-chain
Pursue
Investigate individuals and groups engaged in fraud disrupting their activities, taking away their finances

15. Counter Fraud Risk Based Approach
Financial Assessment Forms must contain anti-fraud caveats, include ‘sharing with other councils’
Modelling of presented circumstances
Risk matrices to determine additional auditing and sampling
Council-wide data cleansed against presented circumstances
Land Registry – Proprietor Search – PN1
Credit Reference Agency – Equifax £1
Counter Fraud

16. Counter Fraud Thank You David Kleinberg
Assistant Director for Fraud & Investigation
Tel:
Counter Fraud