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Legal

Countering Fraud in the NHS

False Qualifications video (Requires Flash )

 

Every year millions of pounds of public money are lost through fraud in the NHS by a small minority of people who feel that this is acceptable behaviour.


Fraud and corruption within the NHS is unacceptable and diverts valuable resources from patient care.

Our aim is to reduce fraud in the NHS to an absolute minimum and then ensures that it stays at that level permanently.

The primary purpose of this site is to promote the work that goes on within South Tyneside NHS Foundation Trust in the fight to counter fraud and to ensure that you know what to do and who to contact if you suspect a fraud is being carried out against the NHS.

Anyone who is undertaking a fraudulent activity within or against South Tyneside NHS Foundation Trust is not acting in the best interests of the patients or the NHS.

Please help us to stop any fraud.

Local Counter Fraud Specialists
Kathryn Wilson
Paul Bevan

What is Fraud?


English law defines fraud within The Fraud Act 2006 and replaces the previous deception offences contained under the Theft Acts 1968 and 1978.

The new fraud specific offences are:

  • By false representation
  • By failing to disclose information
  • By abuse of position
  • Possession of articles for use in frauds
  • Making or supplying articles for use in frauds
  • Obtaining services dishonestly

Who might commit fraud against the NHS?

There is no single profile of an NHS fraudster. Fraud can be committed by staff including Doctors, nurses and Chief Executives; as well as by patients, contractors, suppliers and visitors. In fact, anyone who comes into contact with the NHS can commit fraud. These include:

  • STAFF
  • PATIENTS
  • CONTRACTORS
  • SUPPLIERS
  • VISITORS

What Areas are Susceptible to Fraud

There are many areas susceptible to fraud in the NHS including:

Staff

  • Travel Expenses – claiming for extra journeys or mileage not done
  • Qualifications – false or exaggerated; medical, academic or professional
  • False identification documents
  • Sickness/Attendance – working at other jobs whilst on sick with the NHS
  • Timesheets – falsely claiming for time not worked; altering after authorisation
  • Invoices/Ordering – over-ordering and using excess for personal use.

Patients

  • Prescriptions – signing falsely as exempt; manipulation
  • Identity – multiple registrations with GP’s etc.

Suppliers/contractors

  • Bogus request for payment
  • Collusion with employees to obtain contracts

National and Local Arrangements

There is a national body to steer counter fraud action called NHS Counter Fraud. In addition to this there are 9 regional teams covering specific areas. At a local level the Local Counter Fraud Specialists (LCFS) are tasked by the Secretary of States Directions to investigate NHS frauds. The LCFS reports directly to the Director of Finance.

What happens to those who commit fraud?

There are three primary avenues open to the Trust to deal with those found committing fraud.

Criminal Action – this could include such things as prosecution or police caution. The evidence required in these cases is the criminal burden of proof, which is beyond reasonable doubt.

Disciplinary Action – this could include such things as verbal or written warnings, demotion or dismissal. The evidence required in these cases is the civil burden of proof, which is on the balance of probabilities.

Civil Recovery Action - used to get the stolen money back.

Please note that the outcomes stated above are not exhaustive and that the Trust can apply ALL THREE types of sanction simultaneously (Criminal, Disciplinary AND Civil Recovery) if appropriate. Where the fraud is committed by a health professional a referral will be made to the professional body (e.g. GMC, HPC, NMC, etc.) for their investigation. Ultimately this could lead to the individual being struck off.

Where the fraud is committed by people who are not employed by the NHS the options open to the NHS would be criminal action, civil recovery and/or termination of a commercial contract.

Your Responsibilities

Be aware that people try to defraud the NHS

Do your best to help us create an anti-fraud culture

Only claim prescription exemption when you are sure that you are exempt – anyone claiming an exemption falsely may have to pay a penalty charge of up to £100 (in addition to the cost of the prescription/s). Persistent offenders may be dealt with through the criminal courts

Don’t be afraid to report any suspicions (see how to report fraud page)

Do the right thing

How to report fraud

Fraud should be reported immediately to either the LCFS or Director of Finance. The LCFS for South Tyneside NHS Foundation Trust are:

Kathryn Wilson
Sunderland Internal Audit Service, 1st Floor Children's Centre, Durham Road, Sunderland, SR3 4AG
Kathrynanne.wilson@chs.northy.nhs.uk
Tel: 0191 5699665 - Ext: 45216
Fax: 0191 5699210

Paul Bevan
Sunderland Internal Audit Service, 1st Floor Children's Centre, Durham Road, Sunderland, SR3 4AG
Paul.bevan@chs.northy.nhs.uk
Tel: 0191 5699665 - Ext: 42333
Fax: 0191 5699210

Alternatively, you can contact the NHS National Fraud Reporting Line on:
0800 028 40 60 or www.nhsbsa.nhs.uk/fraud

Recent cases

Please follow the below link for further information:
http://www.nhsbsa.nhs.uk/CounterFraud/438.aspx

Other Services

 Presentations

If you are a part of a patient group and you would like a general overview of fraud within the NHS please contact the LCFS to discuss your requirements.

Proactive counter fraud work

In addition to the investigation of allegations of fraud the LCFS undertakes exercises into areas of work with a potential high risk of fraud.

Random checks on patient prescription exemptions are carried out throughout the year

Useful Links

Also check out the following links to the NHS Counter Fraud Service

Contact Details

Please find below the relevant contact details

Kathryn Wilson
Sunderland Internal Audit Service, 1st Floor Children's Centre, Durham Road, Sunderland, SR3 4AG
Kathrynanne.wilson@chs.northy.nhs.uk
Tel: 0191 5699665 - Ext: 45216
Fax: 0191 5699210

Paul Bevan
Sunderland Internal Audit Service, 1st Floor Children's Centre, Durham Road, Sunderland, SR3 4AG
Paul.bevan@chs.northy.nhs.uk
Tel: 0191 5699665 - Ext: 42333
Fax: 0191 5699210