Countering Fraud in the NHS

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What is fraud and how does it impact the NHSAudit Yorkshire Logo

Fraud is committed when a person deliberately makes a dishonest representation in order to make a gain or to cause a loss to someone else. For example, if someone stated on their expenses claim that they had travelled 50 miles when really they had only travelled 10, this would be fraud. The person has made a false representation in order to make a gain.

Fraud comes in many different forms. The NHS Counter Fraud Authority (NHSCFA) has produced a reference guide which provides loads of different examples of how the NHS can be affected by fraud – you can find the full guide here.  At the latest estimate, it is believed that the NHS loses over £1.2 billion a year to fraud. NHS fraud diverts public funds away from the services that we all pay for, and into the pockets of dishonest people.

The role of the Local Counter Fraud Specialist (LCFS)

NHS North East Lincolnshire Clinical Commissioning Group has a dedicated Local Counter Fraud Specialist (LCFS). The role of the LCFS has several strands, and is overseen by the Chief Finance Officer at a local level, and by the NHSCFA at a national level. Your LCFS will ensure your employer is meeting the standards set by the NHSCFA that policies and procedures are fraud proof, and that staff are encouraged and enabled to learn more about NHS fraud. The LCFS is also responsible for investigating allegations of fraud, bribery and corruption. Your LCFS is here to help. If you have concerns about fraud affecting the NHS, please do get in touch with them for advice.

Your Local Counter Fraud Specialist

Name                                Nikki Cooper

Contact email                    nikki.cooper1@nhs.net

Contact numbers               01482 866800/07872 988939  

If you have concerns about fraud you can report it through the following channels:

  • Directly to your LCFS using their contact details listed above
  • Directly to the Chief Finance Officer, Laura Whitton
  • By contacting the NHSCFA reporting line on 0800 028 4060
  • By completing an online report https://reportfraud.cfa.nhs.uk/

All reports will be dealt with confidentially. Please note that the best route for reporting is to speak to your LCFS. If you would prefer to make an anonymous report via the NHSCFA hotline or web form, please provide as much detail as possible as the LCFS will not be able to get back in touch with you to ask for any further information or clarification about your concerns.

Examples of types of fraud

  • Patient Travel Expenses – a patient in receipt of qualifying benefits may claim travel expenses for secondary care appointments. If the person submits claims for additional journeys that they didn’t actually take, this would be fraud.
  • Mandate Fraud – a fraudster contacts an NHS finance team pretending to be a genuine supplier. They request that the suppliers’ bank details are updated, and the next payment made to the supplier is diverted into the fraudster’s bank account.
  • Working Whilst Sick – a person is signed off sick from their NHS role but then works elsewhere during their sick leave.

Fraud Champion

The role of the Fraud Champion is to raise awareness of fraud, to understand the risks posed by fraud, and to understand best practice in countering fraud. The Fraud Champion and the LCFS work closely to ensure that efforts are coordinated and effective. The Fraud Champion for NEL CCG is:

Name                  Corporate Assurance Officer 

Contact email      NELCCG.GovernanceTeam@nhs.net

Think FRAUD:

F – Find the contact details for your LCFS

R – Report your concerns

A – Ask the LCFS to talk to your team

U – Use your LCFS for advice and information

D -  Don’t try to investigate the matter for yourself

Relevant links

CCG Anti-Fraud Bribery & Corruption Policy