Audit South West NHS Counter Fraud Service.1 Countering Fraud in the NHS. Gareth Cottrell MSc Counter Fraud Specialist Fraud Awareness Presentation

Learning outcomes Describe Fraud as an offence. Describe Fraud as an offence. Understand how fraud affects the NHS. Understand how fraud affects the NHS. Understand the NHS response to fraud. Understand the NHS response to fraud. Identify fraud. Identify fraud. Know what to do if you spot fraud. Know what to do if you spot fraud. Audit South West NHS Counter Fraud Service.2

Description of fraud. Misrepresentation. Misrepresentation. Failure to disclose information. Failure to disclose information. Abuse of position. Abuse of position. Possession/making/supplying articles for use in a fraud. Possession/making/supplying articles for use in a fraud. Fraud is usually a string of offences, not a one-off incident. Fraud is usually a string of offences, not a one-off incident. Audit South West NHS Counter Fraud Service.3

4 Who can commit fraud against the NHS? The public – e.g. patients falsely claiming free treatment – prescriptions, false identity, health tourism. Suppliers and contractors – e.g. Supplying goods of a lower quality than specified/ordered, supplying fewer goods than ordered, submitting false invoices, exaggerated claims for treatment. Staff – e.g. timesheet frauds, false ordering of goods, taking sick leave when they’re not really sick.

Audit South West NHS Counter Fraud Service.5 What is the NHS doing about it? Reactive. Anyone can report a suspicion of fraud to us. Anyone can report a suspicion of fraud to us. Proactive Risk Measurement. Risk Measurement. National Exercises. National Exercises. Local Exercises. Local Exercises. National Fraud Initiative. National Fraud Initiative.

Audit South West NHS Counter Fraud Service.6 Parallel Sanctions Criminal (Beyond reasonable doubt) Disciplinary (Balance of probability, but in some circumstances may be beyond reasonable doubt) Civil (Balance of probability)

Audit South West NHS Counter Fraud Service.7 Some examples of fraud Agency driver – parked his car at Park & Ride. Agency driver – parked his car at Park & Ride. Collected works van and fuel card. Collected works van and fuel card. Returned to his car and collected 2 jerry cans. Returned to his car and collected 2 jerry cans. When refuelling works van also filled the jerry cans. When refuelling works van also filled the jerry cans. Arrested on Park & Ride site:- Arrested on Park & Ride site:- –formal police caution and sacked from the agency where he’d worked for 14 years.

Audit South West NHS Counter Fraud Service.8 Some examples of fraud Band 5 nurse on sick leave with Plantar Fascilitis (inflammation in the foot). Band 5 nurse on sick leave with Plantar Fascilitis (inflammation in the foot). Found to have worked 5 shifts of up to 11 hours duration over a 10 day period of her sick leave for a private hospital doing very similar duties to her NHS role. Found to have worked 5 shifts of up to 11 hours duration over a 10 day period of her sick leave for a private hospital doing very similar duties to her NHS role. Dismissed by the Trust and possible effect on pension. Dismissed by the Trust and possible effect on pension.

Some examples of fraud. Locum Doctor stole a prescription and made it out impersonating a fellow doctor. Locum Doctor stole a prescription and made it out impersonating a fellow doctor. Stole a 2 nd prescription from another hospital and made it out to herself. Stole a 2 nd prescription from another hospital and made it out to herself. Police caution, conditions on licence to practice and eventually erased from the Medical Register. Police caution, conditions on licence to practice and eventually erased from the Medical Register. Audit South West NHS Counter Fraud Service.9

10 Bribery Bribery Act 2010 – Came into force 1 July Bribery Act 2010 – Came into force 1 July Offence to offer or receive a bribe. Offence to offer or receive a bribe. Offence to “fail to prevent a bribe”. Offence to “fail to prevent a bribe”. Under some circumstances can have world wide jurisdiction. Under some circumstances can have world wide jurisdiction.

Audit South West NHS Counter Fraud Service.11 Your Local Counter Fraud Specialist: - Gareth Cottrell NHS Counter Fraud Service Carlyon House Royal Cornwall Hospital, Treliske Cornwall TR1 3LJ Tel: Mobile: NHS.UK