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NHS Fraud Awareness Presentation Staff Induction Event

COUNTERING FRAUD IN THE NHS. NHS Fraud Awareness Presentation Staff Induction Event. COUNTERING FRAUD IN THE NHS. NHS Counter Fraud Service – set up in 1998 to: Tackle all losses to fraud and corruption in every area of NHS spending.

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NHS Fraud Awareness Presentation Staff Induction Event

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  1. COUNTERING FRAUD IN THE NHS NHS Fraud Awareness Presentation Staff Induction Event

  2. COUNTERING FRAUD IN THE NHS NHS Counter Fraud Service – set up in 1998 to: Tackle all losses to fraud and corruption in every area of NHS spending. Address problem of the minority who try to defraud the NHS of it’s valuable resources. Reduce fraud to an absolute minimum and hold it at that level to release resources for better patient care.

  3. COUNTERING FRAUD IN THE NHS What is Fraud? Stealing (dishonesty) with an element of deception. Fraud Act 2006 simplified Fraud into 3 main areas: • Acts of Omission • False Representation • Abuse of position What is Corruption? The offering, giving, soliciting, or acceptance of inducements which may influence a persons actions.

  4. COUNTERING FRAUD IN THE NHS STRUCTURE: Central Unit: Operations Quality & Training Communications and Business Development Policy Risk / Security Management Unit Specialist Teams: Dental Fraud Team Pharmaceutical Fraud Team National Proactive Team Regional Teams: Counter Fraud Specialists Local Teams: Local Counter Fraud Specialists

  5. COUNTERING FRAUD IN THE NHS • Your Local Counter Fraud Specialist • Every health body in England & Wales has a nominated LCFS to tackle fraud at local level. • Professional accreditation process. • First point of contact to report concerns re fraud. • East Midlands NHS Local Counter Fraud Services • Arrangements- • Team approach-

  6. PERFORMANCE STATISTICS 2007/08 351 cases detected and investigated £4.1m fraud and unlawful action identified £7.5m potential savings from completed investigations £6m recovered (57.5m since 1998) 69 civil and disciplinary sanctions applied 96% Prosecution success rate COUNTERING FRAUD IN THE NHS

  7. COUNTERING FRAUD IN THE NHS Types of Fraud We Investigate Illustration of what kind of fraud occurs in the NHS and some actual case studies… Investigations have covered the whole spectrum of people working in, and using, the NHS.

  8. COUNTERING FRAUD IN THE NHS ABUSE OF POSITION Background • Modern Matron forged signatures on timesheets and swindled over £8,000 from NHS. • Claimed most of the total overtime bill for nurses and midwives. • Faked manager’s signature on claim forms. • Claimed overtime whilst off-sick and once when she was on holiday abroad. Outcome • Sentenced at Leicester Crown Court to 240 hours community punishment • Ordered to pay £1000 costs. • The Trust is currently recovering the defrauded sum.

  9. COUNTERING FRAUD IN THE NHS WORKING ELSEWHERE WHILST ON SICK LEAVE FROM NHS EMPLOYMENT Background • Dietetic Assistant seen working at a private nursing home by a patient. • The patient mentioned this to staff who were aware the employee was on long-term sick leave and reported it to management. • Outcome • Confirmed they had been working whilst claiming sick pay. • Charged with four counts of false accounting. • Sentenced to 120 hour Community Punishment Order and declared bankrupt before the £4,000 defrauded funds could be recovered.

  10. COUNTERING FRAUD IN THE NHS FICTITIOUS MILEAGE CLAIMS Background • Doctor found to have made eight excess travel claims for 175 journeys totalling 21,000 miles. • Falsely claimed excess travel claims between Hull and Leeds hospital, when they had been living in Leeds the whole time. • Outcome • Resulted in a £4,800 loss to the NHS. • Doctor pleaded guilty to eight offences of false accounting. • Sentenced to a 12 month Community Punishment Order. • Money repaid to the NHS.

  11. COUNTERING FRAUD IN THE NHS JOB APPLICATIONS – NON-DECLARATION OF CONVICTIONS Background • Temporary medical secretary caught claiming longer hours than she had actually worked. • Forged the authorised signature on the timesheets. • Later applied for a permanent position failed to declare criminal record. Found to have three previous convictions, including a two-year prison sentence for theft from an employer. • Outcome • Pleaded guilty to obtaining a pecuniary advantage and three charges of false accounting. • Sentenced to four months imprisonment for each offence • Ordered to carry-out 150 hours community and to pay £150 compensation and £750 court costs.

  12. COUNTERING FRAUD IN THE NHS FRAUDULENT CLAIMS BY DENTISTS Background • Dentist claimed payment for numerous treatments that had never been provided. • Created over 800 non-existent patients to claim even more money. • 3,800 false claims for payment to the NHS.  • Outcome • Pleaded guilty to fifteen charges of obtaining money transfers by deception. • Sentenced him to four years imprisonment.  • Total loss to the NHS was over £600,000. The case was referred to the GDC for disciplinary action.

  13. COUNTERING FRAUD IN THE NHS OPTICIANS - FALSE CLAIMS Background • Optician accused of forcing five employees to take part in the fraud by making numerous false and inflated claims for payment. • They had issued spectacles to children when none had been dispensed.  • Claimed payment for full replacement of spectacles, when in fact the original spectacles had been repaired. • Outcome • Optician found guilty of conspiracy to defraud and sentenced to two years imprisonment. The fraud was worth about £200,000.  • Three employees pleaded guilty and were sentenced to 12 months imprisonment, suspended for 2 years.

  14. COUNTERING FRAUD IN THE NHS • Patients – claiming exemptions / hospital travel to which not entitled. • Background • Patient pretended to be undergoing treatment for cancer at DRI. She also turned up at the Hospital's reception wearing a head scarf, claiming that she was suffering hair loss as a result of chemotherapy. She told hospital staff that she had had one lung removed and had cancer in the other. • Staff from the Trust checked records and discovered that she had never received treatment at the hospital and no serious illness had been identified. • Receipts from a local transport company were altered to make it look like she had attended the hospital. Outcome • The patient pleaded guilty to all charges and 52 TIC’s at Derby Magistrate's Court. She was sentenced to a £100 fine, £75 costs, and a compensation order amounting to £961.90 and £30 per week re-payments.

  15. COUNTERING FRAUD IN THE NHS Fraudsters Opportunity – weak management or poor system controls Motivation – strong reason to resort to fraud Rationalisation – the ability to justify their actions

  16. COUNTERING FRAUD IN THE NHS Fraud Indicators Stress without high workload First in last out, reluctance to take leave, refusal of promotion Egotistical, risk taker, rule breaker Disgruntled, a complainer Unexplained wealth Sudden change of lifestyle New staff resign quickly Suppliers/contractors deal only with one person Greedy or has genuine financial need

  17. COUNTERING FRAUD IN THE NHS Group Exercise Work in small groups. Identify one area where you feel your directorate/department may be vulnerable to fraud. What might indicate fraud was occurring in this area? How would you stop it? You have 5 minutes to do this.

  18. COUNTERING FRAUD IN THE NHS LCFS Work - Not just investigations…. Developing an ANTI-FRAUD CULTURE. Maximum DETERRENCE of fraud. Successful PREVENTION of fraud that cannot be deterred. Prompt DETECTION of fraud that cannot be prevented. Effective SANCTIONS against people committing fraud. Effective methods for seeking REDRESS of defrauded money.

  19. COUNTERING FRAUD IN THE NHS The NHS Counter Fraud Service Details regarding the work of the NHS Counter Fraud and Security Management Service, and further examples of actual frauds that have been perpetrated against the NHS, can be found on their website: www.nhsbsa.nhs.uk/counterfraud.aspx

  20. COUNTERING FRAUD IN THE NHS • If you are concerned about a fraud taking place within the NHS, you should either: • INFORM THE ORGANISATION’S NOMINATED LCFS: • Leicester City PCT – Richard Holmes • T: (0116) 295 3166. E: richard.holmes@emias.nhs.uk. • Joanna Clarke T: (0116) 295 3159. E: joanna.clarke@emias.nhs.uk • NHS Leicester County & Rutland and Leicester Partnership Trust – • Richard Holmes T: (0116) 295 3162. E: richard.holmes@emias.nhs.uk • Joanna Clarke T: (0116) 295 3159. E: joanna.clarke@emias.nhs.uk • 2. CALL THE CONFIDENTIAL NHS FRAUD & CORRUPTION • REPORTING LINE :0800 028 40 60(Freephone – Mon to Fri – 8am-6pm) • 3. COMPLETE A CFS1 REFERRAL FORM. • All calls are: • Treated in the strictest confidence. Dealt with by trained staff. Professionally investigated.

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