Counter Fraud
All NHS organisations are required by the NHS Counter Fraud Authority (the NHS body responsible for tackling all forms of crime against the NHS), to have in a Local Counter Fraud Specialist (LCFS) to combat fraud, bribery and corruption, and help safeguard NHS resources.
Our provider is CW Audit. Their LCFS’s are accredited and qualified to the required national standard to do this work.
Anyone who has suspicions of fraud within NHS Shropshire, Telford and Wrekin can approach the LCFS confidentially and anonymously. This includes employees, agency staff, contractors and members of the public.
The activities of the LCFS include:
- Carrying out an agreed programme of preventative counter fraud and corruption activity
- Deciding whether internal/external referrals or matters raised through the whistleblowing process need to be investigated
- Investigating cases in accordance with the NHS Standard Contract (Service Condition 24) and the NHS Fraud and Corruption Manual; ensuring a full and fair investigation
- Reporting to the Executive Director of Finance (EDoF) to ensure she is kept up to date on all cases
- Reporting to the Audit Committee on all counter fraud work undertaken at the ICB
- Reporting any case to the police where necessary, in consultation with the EDoF, the Chief Accountable Officer and the NHS Counter Fraud Authority
The ‘Failure to Prevent Fraud’ offence was primarily created to target large corporate organisations and companies using ‘Companies House’ to commit fraud. However, because of how the legislation defines an organisation, it also applies to the NHS.
The legislation states:
Organisations can be criminally liable if a connected person (employee) or other associated person commits fraud with the intention of benefitting the organisation or a related body AND there were no reasonable fraud prevention procedures in place.
As most frauds are committed with the intention of benefiting an individual and not the organisation, occurrences will be few and far between, but that does not mean this will never happen.
The legislation states ‘AND there were no reasonable fraud prevention procedures in place’.
So, if we can show that there were reasonable fraud prevention procedures in place, our organisations may have a defence and avoid prosecution.
The fraud prevention procedures are listed as:
- Due diligence
- Communication
- Monitoring and Review
- Risk based prevention
- Risk assessment
- Top level commitment
Please consider viewing the attached links which offer further information
- Watch a recording of MIAA's Failure to Prevent Webinar
- Download slides from the webinar
- NHS Counter Fraud Authority’s FAQ section on this offence
- Download a copy of MIAA’s FAQs
How can I report suspicion of fraud?
If you’re reporting a suspicion of fraud, bribery or corruption, against the NHS, please provide as much information as possible. We can also offer you advice if you have a concern but are not sure if it is a fraud against the NHS.
For more information about the process, take a look at this fraud reporting flowchart.
A copy of the ICB's Fraud, Bribery and Corruption Policy can be found here.
Our Anti-Fraud Specialist is:
Claire Taylor
Tel: 07552 297469
Email: Claire.Taylor@miaa.nhs.uk
You can also report any concerns using the following referral form.
Our own Counter Fraud Champion is Angela Szabo who can be contacted directly by emailing angela.szabo2@nhs.net.
Other members of team are:
Leanne Hawkes: leanne.hawkes@nhs.net
Craig Bevan-Davies: craig.bevan-davies@nhs.net
Matthew Curtis: matthew.curtis1@nhs.net
Malcolm Taylor: malcolm.taylor4@nhs.net
Information for witnesses
You may be required to be a witness because you have seen or been in contact with an aspect which relates to an investigation which is being conducted on behalf of NHS Shropshire, Telford and Wrekin, by either by the LCFS or the Police.
All members of staff are required to co-operate with any fraud investigation and provide evidence or be a witness. Failure to co-operate with an investigation by a member of staff, may result in disciplinary action.
All witnesses will be fully supported by the LCFS and NHS Shropshire, Telford and Wrekin.
The NHS Counter Fraud Authority (NHSCFA) has produced eight fraud prevention quick guides focusing on specific areas of fraud risk vulnerability in NHS finance and procurement.
Procurement accounts for a significant amount of NHS spend and activity. These guides are aimed at helping organisations put control and preventative measures and actions in place to reduce the NHS’s vulnerability to procurement fraud.
Each quick guide covers the following topics:
- Brief summary of the fraud risk
- How to spot fraud
- How to stop fraud from happening
- How to report suspicions of fraud
The guides can be found by following this link.
The Fraud Act 2006 is the primary piece of anti-fraud legislation in the UK. It has been in force since January 2007.
The Act gives a definition of the criminal offence of fraud and defines the three ways of committing it - fraud by false representation, fraud by failing to disclose information, and fraud by abuse of position.
It also sets out the offence of obtaining services dishonestly and of possessing, making and supplying articles for use in frauds.
Click here for a summary of the Fraud Act 2006.
The Bribery Act 2010 came into force on 1 July 2011.
The Bribery Act has become the primary piece of anti-corruption legislation in the UK and is arguably one of the most far-reaching Acts of its kind in the world.
For more information, take a look this short summary of the Bribery Act 2010.
NHS Shropshire, Telford and Wrekin takes part in the Cabinet Office’s National Fraud Initiative (NFI) exercise. This mandatory exercise takes place every two years and includes all NHS bodies and Councils in England, amongst other public sector and private sector organisations.
NFI matches electronic data within and between public and private sector bodies to prevent and detect fraud.
We are required to provide specific data to the Minister for the Cabinet Office for matching for each exercise. The use of data by the Cabinet Office in a data matching exercise is carried out with statutory authority under Part 6 of the Local Audit and Accountability Act 2014.
It does not require the consent of the individuals concerned under the Data Protection Act 1998. This is because data matching by the Cabinet Office is subject to a Code of Practice. We will take appropriate steps to let individuals know about the collection and use of their personal data. We will follow the requirements set out in the General Data Protection Regulation and the Data Protection Act 2018 and inform individuals that personal data will be disclosed to fraud prevention (and/or detection bodies) to help in the prevention and detection of fraud.
If you have any queries about the NFI, please speak to Paul Westwood, Local Counter Fraud Specialist, who can be contacted by secure email at the following addresses:
Below are a few examples of the types of fraud which are investigated across the NHS throughout England and Wales by Local Counter Fraud Teams (although this list is not exhaustive):
Staff
- Use of false qualification certificates and references in order to gain employment
- Claiming for hours not worked
- Working whilst off sick
- Claiming for travel and other expenses not incurred
- Managers obtaining goods and services for personal use
- Creation of ghost employees
GP Contractors
- Creating ghost patients
- Claiming for services provided to ghost employees including production of false prescriptions
- Claiming for services not provided (enhanced services)
- Raising false prescriptions for self-medicating
- Accepting bribes to register overseas visitors
Other Contractors
- Pharmacists claiming for medication not dispensed
- Pharmacists claiming for services not provided
- Failure to declare prescription charges collected
- Creation of claims for ghost patients – (dentists and opticians)
- Dentists claiming for higher number of Units of Dental Activity than provided
- Optician claiming NHS allowances for individuals who are not entitled
Patients
- Amending prescriptions to gain additional medication
- Gaining multiple registrations with GP’s in order to obtain additional medication
- Overseas visitors using false documents in order to gain NHS services
- Patients selling their medication
