See also: Counter Fraud and Security Management Service

Tackling Fraud in the NHS

Directorate of Counter Fraud Services Briefing Note

The aim of this briefing is to let you know how you can help to combat fraud locally, and who you can contact within your organisation for advice and guidance.

Every year, millions of pounds are being diverted from the National Health Service through fraud, corruption and error. The vast majority of staff within the NHS are professional and honest, but there are a small minority who think that such behaviour is acceptable. This deprives the NHS of valuable resources which should be focussed on improving patient care. Examples of fraud within the NHS range from the submission of false travel claims by staff and intentional evasion of NHS charges by patients, to complex and high value fraud, sometimes involving millions of pounds.

The Directorate of Counter Fraud Services (DCFS) was set up in September 1998 with a remit to counter all fraud and corruption within the NHS, with a specific priority for countering fraud in the Family Health Services. In the past two years the Directorate has concentrated on creating a counter fraud structure within the NHS with the view to:

·         Reduce fraud to an absolute minimum within 10 years

·         Put in place arrangements to hold fraud at an absolute minimum level, permanently

·         Free up resources for better patient care

The DCFS has recruited dedicated specialists to counter fraud within the NHS. The Counter Fraud Operational Service (CFOS) has specialist teams working in each of the NHS regions, supported by a national proactive team and a team working to investigate pharmaceutical fraud. A Dental Fraud Team will also be established later this year.

In addition, there are Local Counter Fraud Specialists (LCFS) situated in each Health Authority, NHS Trust and Primary Care Trust. Each LCFS has received professional training and is accredited as a counter fraud specialist through the Institute of Criminal Justice Studies. All staff are trained to conduct their work in a professional, confidential and ethical manner.

LCFSs have a vital role to play within the counter fraud structure. They act as the “first line of defence” against fraud and corruption within Health Bodies. Working closely with CFOS, they will apply their practical knowledge of the environment within which they work, together with the skills they have developed through training, to be an effective weapon in tackling fraud and corruption.

Underpinning this structure is the counter fraud strategy outlined in “Countering Fraud in the NHS”, the main components of which are:

The creation of an anti-fraud culture

Everyone has a part to play in the fight against fraud, whether it be the public, NHS staff, professionals, managers or policy makers. We must work together to raise fraud awareness and enforce the message that fraud within the NHS is not acceptable and will not be tolerated. We all have a responsibility to protect our organisation and its resources.

Maximum deterrence of fraud

The most effective deterrent will come from those of us within the NHS who value the services provided and disapprove of those who abuse the systems through fraud. In addition,  publicity surrounding our counter fraud work will deter some who perpetrate or consider perpetrating fraud.

Successful prevention of fraud

If it not possible to deter fraudsters, the next preferable course of action is to prevent fraud from succeeding. Robust systems are essential, so that if fraud is attempted, it will fail.

Prompt detection of fraud which cannot be prevented

Detection processes are being developed in order to discover fraud which has not been deterred or prevented.  Early detection of a fraud helps effective investigation and can establish links between different types of  fraud.

Professional investigation of detected fraud

Detected fraud will be investigated by accredited NHS counter fraud specialists in a professional, objective and timely manner.

Effective sanctions, including appropriate legal action against people committing fraud

Following the investigation of fraud, it is important to ensure that appropriate sanctions, whether disciplinary, criminal or civil, are applied to those who have committed fraud.  Advice will be available from DCFS or CFOS on the application of appropriate sanctions.

Effective methods for seeking redress in respect of money defrauded

It is important that resources fraudulently obtained are recovered, wherever possible.  Detailed advice and guidance will be available to support health bodies in their efforts to ensure that fraudsters do not benefit from their crimes, and that the money recovered is put back into patient care.

If you have any concerns regarding fraud and corruption within West Suffolk Hospitals NHS Trust or Walnuttree Hospital, you should contact the local counter fraud specialist:

Melvyn Pettitt
Suffolk Audit Services
tel: 01473 329632 or 01284 829552

More information can also be found on the Counter Fraud and Security Management Service (CFSMS) website: www.cfsms.nhs.uk