Fraud in the NHS is not common but does occur. It is committed by a small minority of staff, patients and outsiders, and diverts money away from patient care. Every health body has an Anti Fraud Specialist working with them, to address issues of possible fraud or bribery either within or against the health bodies that they look after.
What to expect from the Anti-Fraud team
If you make a referral to the Trust’s Anti-Fraud Specialist (AFS), they will discuss your initial suspicions with you and will ask to see any evidence that you have. As far as possible, your identity as the source of the allegation will be kept confidential.
The AFS will also discuss the matter (but not your identity) with the Trust’s Director of Finances and Resources; and agree appropriate next steps.
If required, the AFS will complete further work/enquiries to either prove or disprove the allegation and may liaise with Human Resources and other staff/managers on a strictly need to know basis.
If the allegation is proven, sufficient evidence will be gathered to take appropriate action against those involved. This may result in disciplinary action and / or a criminal prosecution. Action will also be taken to recover any loss resulting from the activity.
Disciplinary and criminal actions can also be pursued concurrently and disciplinary action can be taken even if fraud is not proven to a criminal standard. The AFS will therefore liaise closely with Human Resources on such matters.
Examples of Fraud
The diversity of the NHS means that fraud may arise almost anywhere and be perpetrated by anyone: staff, patients, and outsiders alike. Examples of what might constitute fraud include:
• Falsely claiming to be off sick, then working elsewhere at the same time
• Claiming for hours not worked (eg false overtime or bank hours claims)
• Carrying out private work during NHS time
• Falsifying travel or other expense claims
• Failing to declare criminal convictions, as part of a job application
• Submitting false qualifications and references to obtain employment
• Sending fake invoices to a Finance dept
• Sending fake ‘change of bank account’ letters to a Finance dept
Our Anti-Fraud Arrangements
Finance Director and Audit Committee
The Trust’s Director of Finance and Resources is responsible for overseeing anti-fraud work within the Trust. The Trust’s Audit Committee maintains additional oversight to ensure that required anti-fraud work provides sufficient assurance that known crime risks are being addressed effectively. The Anti Fraud Specialist coordinates anti-fraud activity, based on an annual work plan, and provides regular progress updates to the Audit Committee.
The Trust’s Anti Fraud Specialist (AFS) works with the Trust to deal with any issues of possible fraud or bribery, which might be taking place either within the Trust itself or as a result of outsiders seeking to defraud the Trust in some way. The work of the AFS includes:
• Raising awareness among Trust staff about fraud issues, and encouraging them to raise any concerns that they may have.
• Seeking to build strong preventative measures within Trust processes, so that fraud is prevented from happening, or is detected if it is occurring.
• Investigating any allegations of possible fraud or bribery, gathering evidence that may prove or disprove the allegations, taking witness statements as necessary, interviewing subjects under caution, and preparing prosecution files for submission to the Crown Prosecution Service.
• Working with other Trust departments e.g. Human Resources (HR), to support their work. In particular, supporting HR with any related disciplinary processes that may be appropriate if a member of staff is found to have committed fraud.
NHS Protect is responsible at a national level for overseeing anti fraud work across the NHS. Its intelligence function collates and disseminates national information about common fraud risks and issues. Fraud Prevention notices and Fraud Alerts are also distributed to all Anti Fraud Specialists as necessary. NHS Protect’s National Investigation Service seeks to apprehend those who commit particularly high value or complex frauds against the NHS, and also deals with cases that may involve multiple health bodies.
Who to Contact
It is important that all suspicions of fraud are reported. If you suspect fraud, do not attempt to investigate it yourself. Report your suspicions direct to the Trust’s Anti-Fraud Specialist, to the Trust’s Director of Finance or via the National Fraud and Corruption Reporting Line. All calls are treated in confidence
Anti-Fraud Specialist – Richard Loydall
Telephone: 024 76 536871
Email Address: email@example.com
CW Audit Services, Wayside House, Wilsons Lane, Coventry CV6 6NY
Alternatively, call the NHS national fraud reporting line on 0800 028 40 60, or report your concerns online at www.reportnhsfraud.nhs.uk