Countering Fraud in the NHS

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

Measures to counter NHS fraud were established in 1998, and in 2006 the NHS Counter Fraud and Security Management Service (CFSMS) became part of the NHS Business Services Authority. From 2011 NHS Protect leads on a wide range of work to protect NHS staff and resources from crime; a link to NHS Protect is below.

Local Counter Fraud Specialists (LCFS) are established in all NHS organisations to assist in reducing fraud and corruption to the absolute minimum, and they can only do this with your help. If you are aware of potential fraud or corruption concerning anyone within the CCG, even if this is just a suspicion or a single piece of information, then it is your responsibility to pass this information to your LCFS. LCFS are also responsible for raising awareness of NHS fraud issues locally and are available to speak to staff groups and deliver presentations as appropriate.

By ensuring that we all understand what healthcare fraud may look like, we increase the chances of reducing the threat instead of feeling the effects. If you haven’t already, check out the Recognise What Fraud Looks Like video.

For more information about Countering Fraud in the NHS, please visit the NHS Counter Fraud Authority (NHSCFA) website

How does the CCG fight fraud?

Auditone works closely with the CCG to combat fraud with a team of experienced Counter Fraud Specialists delivering a full range of counter fraud, bribery and corruption services including prevention, detection and investigation. Their professionally qualified Counter Fraud Specialists work to identify potential fraud, bribery and corruption risks and act to reduce and mitigate these risks. They are experienced in carrying out timely criminal investigations, from referral to prosecution.

Auditone is an NHS consortium providing counter fraud services to 33 NHS organisations across the North of England.  It is hosted by Northumberland, Tyne and Wear NHS Foundation Trust and is a not for profit organisation.

How can you help tackle fraud?

If you suspect fraud is occurring, you can help by reporting your suspicions confidentially in one of the following ways:

Contact our Counter Fraud Specialist at Auditone: -

Hotline:         0191 441 5936

Email:            counterfraud@audit-one.co.uk

All calls are made in strictest confidence and no attempt will be made to persuade you to provide your personal details if you want to remain anonymous. You will be given a call reference number which you can quote if you phone again with additional information.

Alternatively, you can forward information to the National Fraud and Corruption Hotline by calling              0800 028 40 60 or you can complete an online reporting form.

Follow these simple guidelines when reporting your suspicions:

•          Do make an immediate note of your concerns

•          Do deal with the matter promptly if you feel your concerns are warranted

•          Don’t do nothing

•          Don’t be afraid to raise your concerns

•          Don’t approach or accuse individuals yourself

•          Don’t try to investigate the matter yourself

The action that you take when you first suspect fraudulent activity may be crucial; do not try to investigate the matter yourself. Attempts to gather evidence by people who are unfamiliar with the law may destroy the case. You will not suffer any recriminations as a result of voicing a reasonably held suspicion. You can remain anonymous if you wish.

Bribery Act 2010

On 1 July 2010 the Bribery Act came into force. This Act makes it a criminal offence for organisations to fail to prevent bribes being paid on their behalf. As a CCG it is important that we fully comply with this Act and that all our staff are aware of what their responsibilities are and the standards of behaviour expected of them.

Dr Peter Melton, Clinical Chief Officer, has produced a statement regarding the Bribery Act. There are also some available here.

There are a number of key points that all staff should be aware of, and these are:

• The Act covers both the offer of a bribe and being bribed
• Bribery can be defined as “offering an incentive (usually monetary) to someone who can take a decision or        action on behalf of others in order to influence that decision”
• It is an offence not only to give, offer, request or receive a bribe, but also to turn a blind eye to bribery within an organisation
• It is an offence to fail to prevent bribery
• Penalties for bribery are severe for both the individual and potentially the organisation

Fraud outside the NHS

For more information and to report other types of fraud, such as benefit fraud or tax evasion, please see:

Report tax evasion
Report any other fraud concerns

Scams

The UK Border Agency have put together a list of the latest tricks and scams in use and gives you advice on protecting yourself. To view the scams, please visit http://www.ukba.homeoffice.gov.uk/aboutus/scams/

The tax office have details of phishing emails on their website, please see http://www.hmrc.gov.uk/security/examples.htm

Related pages

Audit-one Counter Fraud Website
National Anti-Fraud Network
NHS Counter Fraud Authority (NHSCFA)

Related downloads

Local Anti Fraud Bribery and Corruption Policy  (please note this policy is currently under review)

Eliminating Public Sector Fraud.pdf