Impact of fraud on the NHS
It is estimated that the NHS loses £1.21 billion per year, or roughly £3.3 million per day, to fraud. This is taxpayers’ money that is taken away from patient care and falls into the hands of criminals. This is enough money to pay for over 40,000 staff nurses, or to purchase over 5,000 emergency ambulances. When we say ‘fraud’, we refer to a range of economic crimes, such as fraud, bribery and corruption or any other illegal acts committed by an individual or group of individuals to obtain a financial or professional gain.
How does the CCG fight fraud?
AuditOne, the CCG’s counter fraud provider works closely with the CCG to combat fraud. We have a team of experienced counter fraud specialists delivering a full range of counter fraud, bribery and corruption services including prevention, detection and investigation. Our professionally qualified counter fraud specialists work to identify potential fraud, bribery and corruption risks through policy and system reviews and suggest remedial action to reduce and mitigate these risks. We are experienced in carrying out timely criminal investigations, from referral to prosecution.
AuditOne is an NHS consortium providing counter fraud services to 23 NHS and independent health care provider organisations across the North of England. It is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and is a not-for-profit organisation.
Who is the CCG’s counter fraud specialist?
Counter Fraud Specialist
How we help tackle fraud
The CCG has a suite of policies that focus on staff and organisational behaviour. By following these policies, staff working in or associated with the CCG can help prevent fraud. These policies cover the following areas:
- Standards of business conduct – https://sunderlandccg.nhs.uk/wp-content/uploads/2020/01/CO19-Standards-of-Business-Conduct-and-DOI-Policy-5.2.pdf
- Gifts and hospitality policy – https://sunderlandccg.nhs.uk/wp-content/uploads/2020/01/CO19-Standards-of-Business-Conduct-and-DOI-Policy-5.2.pdf
- Declarations of interest policy – https://sunderlandccg.nhs.uk/wp-content/uploads/2020/01/CO19-Standards-of-Business-Conduct-and-DOI-Policy-5.2.pdf
The NHS Counter Fraud Authority have produced some useful reference and prevention guidance documents for NHS organisations. There are several fraud reference guides available which cover the following areas:
- NHS staff – This relates to a person working in, or for, the NHS in any capacity. This includes salaried employees, retired employees receiving an NHS pension, agency staff, trainees, contractors such as GPs, dentists, pharmacists, opticians and their organisations and any other contractors who work for the NHS in the same manner as an employee.
- NHS patients – This relates to a patient, that is someone obtaining treatment, services or medication from the NHS. It may relate to someone using the NHS (either in the UK or abroad) to obtain medical, dental, optical or pharmacy services.
- NHS suppliers – This relates to a person or organisation providing goods and/or services to the NHS. This can include contractors (individuals or companies), suppliers, or other organisations.
- NHS systems – This relates to fraud in relation to financial accounting, performance, incentives or penalties or any other financial issue.
- Third parties – This relates to a person or organisation not linked to the NHS but trying to gain financially from it. This would include a third party making unsolicited requests for payment from the NHS or someone using an NHS facility to which they are not entitled.
There are also eight quick guides which covering different types of procurement frauds to aid prevention of these types of fraud:
- Contract splitting prevention quick guide
- Contract reviews quick guide
- Buying goods and services quick guide
- Due diligence quick guide
- Suppliers’ code of practice quick guide
- Mandate fraud quick guide
- Petty cash fraud quick guide
- Credit card fraud quick guide
How to report fraud
If you suspect fraud is occurring, you can help by reporting your suspicions confidentially to the counter fraud specialist.
Follow these simple guidelines when reporting your suspicions:
- Do make an immediate note of your concerns
- Do deal with the matter promptly if you feel your concerns are warranted
- Don’t do nothing
- Don’t be afraid to raise your concerns
- Don’t approach or accuse individuals yourself
- Don’t try to investigate the matter yourself
How to contact a Counter Fraud Specialist
The CCG’s counter fraud specialist can be contacted via the following:
Fraud Hotline: 0191 441 5936
You can also report suspicions of fraud to the chief finance officer
Contact the National Fraud and Corruption reporting line
Alternatively, you can phone the National Fraud and Corruption reporting line: 0800 028 40 60
All calls are made in strictest confidence and no attempt will be made to persuade you to provide your personal details if you want to remain anonymous. You will be given a call reference number which you can quote if you phone again with additional information.
Finally, you can report allegations of fraud online directly to the NHS Counter Fraud Authority at https://cfa.nhs.uk/reportfraud
Each NHS organisation is required to nominate a fraud champion whose role is to support the counter fraud specialist in promoting awareness of fraud across the CCG. The CCG’s fraud champion is Bill Bailey. Staff should be aware that fraud champions are not authorised to investigate allegations of fraud. Therefore, staff should not report suspicions to fraud champions.
Fraud, bribery and corruption policy – https://sunderlandccg.nhs.uk/wp-content/uploads/2019/10/CO06-Counter-Fraud-Bribery-Corruption-Policy-4.pdf
Fraud awareness videos:
- Patient travel claims
- Fraud by abuse of position
- Fake Qualifications
- Invoice Fraud
- Working whilst sick
- Timesheet fraud