Countering Fraud, Bribery & Corruption

Copyright © 2014 360 Assurance

All rights reserved

The aims of this booklet are:

To inform you about the risk of fraud, bribery and corruption that might affect the CCG

To introduce your Counter Fraud Specialist

To explain what you should do if you

uncover a possible fraud

Why do you need to know about Fraud, Bribery & Corruption?

All areas of NHS spending are affected by fraud, bribery and corruption. With CCGs responsible for a significant proportion of this spending, it is imperative that all staff are aware of the risks that exist because staff are ideally placed to contribute to the prevention and detection of fraud, bribery & corruption.

In recent years GP practices have also lost significant sums of money through criminal acts and so an understanding of these risks is also important for their practice staff.

We are ALL responsible for ensuring that fraud cannot easily be carried out by correctly following relevant policies and procedures and by promptly reporting any concerns that we have.

A body was first established to deal with crime within the NHS in 1998. This body is now known as NHS Protect. It exists to direct efforts to fight crime nationally and sets out standards by which health bodies’ response to crime can be measured.

NHS Protect has a number of teams performing different duties:

National policy guidanceQuality assuranceNational Investigation ServiceLiaison with health bodies’ Counter Fraud Specialists via Area Anti-Fraud Specialists

NHS Protect

The CCG is required to ensure it has adequate processes in place to mitigate the risk of fraud. Your Counter Fraud Specialist works with the Chief Finance Officer and other senior officers to carry out a plan of work designed to do a number of things:

Educate staff to ensure the CCG has a culture that is intolerant of fraud, bribery and corruption;

Deter would-be fraudsters by publicising successful prosecutions;

Prevent fraud by ensuring appropriate policies and procedures are in place and are adhered to;

Detect fraud by carrying out proactive exercises;

Investigate fraud, bribery and corruption where suspicions exists and ensure that all available sanctions are used against those found to have acted dishonestly.

Your Counter Fraud Specialist

The most common offences under the Fraud Act 2006 are:

Fraud by false representation

Fraud by failing to disclose

Fraud by abuse of position

(Some fraud offences, committed before 15th January 2007, continue to be prosecuted under the Theft Acts)

What is Fraud?

Fraud by False Representation

There are numerous ways in which somebody might falsely represent or falsify information in order to make a gain for themselves or expose another to a loss. Examples of this would include, but are not limited to:

The falsification of staff timesheets or expense claims;

Pharmacies falsely endorsing prescription forms after dispensing and/or conspiring with wholesalers and overstating the cost of specials;

Providers inflating the costs attributed to Continuing Care by invoicing for additional costs for services that have not been delivered;

Patients creating false identities in order to register with multiple practices and increase the amount of medication they are prescribed;

Criminal gangs purporting to represent existing creditors by using mocked up letters and other documents in order to change creditor bank details to their own.

Fraud by Failing to Disclose

A fraud is also committed when somebody has a legal duty to disclose information but dishonestly fails to do so in order to make a gain for themselves or expose another to a loss. Examples of this would include, but are not limited to:

Staff failing to report salary overpayments and keeping the money for their own benefit;

Staff failing to declare that they are subject to a criminal investigation and/or prosecution where this is a requirement of their employment;

Failure to declare all outside interests as they arise allowing conflicts of interest to occur

Fraud by Abuse of Position

Here, a fraud is committed where somebody uses their position to dishonestly make a gain for themselves or expose another to a loss. Examples of this would include, but are not limited to:

A GP Practice Manager using their position of trust in order to increase their salary, redirect payments to their own accounts and/or order goods for personal use;

A CCG member or staff member with outside interests inappropriately using their position to influence CCG decisions in such a way as to ensure they make a gain and/or another party makes a loss;

A staff member using their position to cause payments to be made that would not otherwise be made (for example to the bank account in their name or that of a family member).

There are a range of other offences which can be considered in relation to fraud, bribery and corruption. These include:

Conspiracy to Defraud

Making articles for use in frauds (for instance forged identity documents)

Computer Misuse

Other Fraud-Related Offences

Making articles for use in a fraudCase Example

Background A prescriber issued prescriptions in the names of friends and relatives in

order to self-prescribe. Following investigation, the prescriber admitted this when Interviewed Under

Caution by the LCFS.

Outcome Received a Police caution as a result of the LCFS

investigation. Summarily dismissed from NHS post. Professional body imposed an interim suspension

order pending a full investigation and hearing.

Bribery is offering an incentive to someone to do something which they wouldn’t normally do. In the context of the Bribery Act 2010, the offence of bribery refers to both the acceptance and the offer (whether or not the offer is accepted) of a bribe.

Any individual associated with an organisation acting in such a way may be prosecuted under the Act for a primary bribery offence, or for conspiracy to commit the offence with others.

The Bribery Act 2010 introduced a new corporate offence meaning that organisations will be exposed to criminal liability, punishable by an unlimited fine, for failing to prevent bribery.

The Bribery Act 2010

What do I do if I think fraud, bribery or corruption is occurring?

Do make a note of your suspicions. Sign the note, date it and keep it safe

Do try to secure or copy documents you believe to be suspicious

Do immediately contact your Counter Fraud SpecialistIan Morris 0116 225 6120

Don’t investigate the matter yourself or report it to anyone other than the Counter Fraud Specialist – this may compromise any potential prosecution.

Don’t undertake any covert surveillance – this willbreach the Human Rights Act.

What if I am wrong?

Never be afraid to raise your suspicions directly with your Local Counter Fraud Specialist even though you may be wrong…You could be right!

There will be no ramifications for raising an issue you believe to be fraud, bribery or corruption, regardless of how the investigation is concluded, as long as your referral was raised in good faith.

If you are uncertain of whether a referral is needed, you should contact your Counter Fraud Specialist anyway for advice.

The person investigated will not be disadvantaged if the investigation undertaken does not uncover any fraud, bribery or corrupt activity.

What if I am right?

The LCFS will have validated the suspicions and uncovered evidence.

The person under investigation will have explained their actions at a formal interview under caution. (Whatever is said can be used in a criminal prosecution).

A decision will be reached regarding appropriate sanctions to be pursued.

Any ongoing loss will be stopped, losses incurred calculated and a decision will be made regarding appropriate recovery action.

Yes, and anonymous referrals will be investigated.

It can be useful to have your contact details, however, even if you only give a contact reference and telephone number. This may help with the investigation as initial enquiries might prove inconclusive and we may therefore need to come back to you for further information.

If you do give us minimal contact details these will not be used to identify you.

Can I report my suspicions anonymously?

What have you learnt from this module so far?

Here are a few questions…

Why do CCG and practice staff need to be aware of Fraud, Bribery & Corruption?

For both of the reasons listed.

Because they can help to prevent fraud by correctly following relevant policies and procedures.

Because they are ideally placed to contribute to the prevention and detection of fraud, bribery & corruption.

CCG and practice staff need to be fraud, bribery and corruption aware because they are ideally placed to contribute to the prevention and detection of fraud, bribery & corruption, and also because they can help to prevent fraud by correctly following relevant policies and procedures.

Why do CCG and practice staff need to be aware of Fraud, Bribery & Corruption?

Which of the following scenarios could be considered fraudulent?

A pharmacist endorsing a prescription with a drug that was not dispensed

A Practice Manager using practice funds to purchase personal items

All of the above.

An applicant for a CCG post providing false educational certificates

All the options listed are potential frauds.

Which of the following scenarios could be considered fraudulent?

You think a false claim for payment may have been made. What should you do?

Contact your Counter Fraud Specialist and ask for advice.

Immediately challenge the individual or organisation presenting the claim.

Take no action as somebody else will take action if it is incorrect.

You think you have beenpresented with a false claim for payment.

What should you do?

If you think you have identified a false claim for payment, whether or not you think that it has been deliberately falsified, you should discuss yourconcerns with your Counter Fraud Specialist:

Ian Morris 0116 225 6120

How do I contact my Counter Fraud Specialist?

Ian MorrisIan.morris@360assurance.nhs.uk 0116 225 6120 360 Assurance,

Riverside House, Bridge Park Road, Thurmaston, Leicester LE4 8BL

You can also call the National NHS Fraud and Corruption Reporting Line (open 8am – 6pm) on 0800 028 40 60, or report online at www.reportnhsfraud.nhs.uk.