NHS Counter Fraud Authority

Anti-fraud and corruption

The NHS Counter Fraud Authority estimates that in 2016-17 losses to fraud and other economic crime in the NHS exceeded £1.25 billion. These are funds that if available, could pay for over 22,000 GPs or purchase over 5,000 frontline ambulances.

Solihull Clinical Commissioning Group has an anti-fraud team which is provided by CW Audit services. The role of the anti-fraud team is to help protect the resources of the CCG by raising awareness of fraud, bribery or corruption affecting the NHS and, when necessary, investigating any offences committed against the CCG. The team is made up of a number of dedicated anti-fraud specialists who, between them, have significant experience of combating fraud in the public sector.

How to report fraud

There are a number of ways that you can report any concerns you have concerning the CCG:

All concerns will be treated in the strictest of confidence and can also be made anonymously. A thorough investigation will be carried out and, where appropriate, the offenders prosecuted. It may be necessary to involve the police in any investigation.

What is fraud?

For an offence to have occurred, the person must have acted dishonestly with the intent of making a gain for themselves or for anyone else, or inflicting a loss (or risk of loss) on another. In January 2007 The Fraud Act came into force and introduced three main fraud offences:

  • False representation
  • Failure to disclose information
  • Fraud by abuse of position

Offences proven under the Fraud Act carry strong sentences on summary conviction; (Magistrates Court) imprisonment up to a maximum of 12 months or an indictment (Crown Court) imprisonment up to a maximum of 10 years. Fines can also be imposed by either court.

When investigating offences against the CCG, the anti-fraud team will also rely on other legislation including: the Theft Act 1968; Computer Misuse Act 1990; Criminal Procedure and Investigation Act 1996; and the Police and Criminal Evidence Act 1984, when establishing if an offence has occurred.

What is bribery?

The Bribery Act reforms the criminal law of bribery, making it easier to tackle this offence proactively in the public and private sectors. In July 2011 The Bribery Act came into force and introduced three main bribery offences:

  • Offering, promising or giving a bribe to another person
  • Requesting, agreeing to receive or accepting a bribe
  • Failure of a commercial organisation to prevent bribery (corporate offence)

Corporate offence is a strict liability offence and an organisation and its senior management can be found guilty of attempted or actual bribery on the organisation’s behalf, if the organisation fails to have in place proper procedures to prevent bribery taking place. Like the Fraud Act, the Bribery Act also imposes strong sentences on conviction. The first case has been heard in court, and for receiving a £500 bribe the defendant was sentenced to six years in prison.

NHS Counter Fraud Authority  

The NHS Counter Fraud Authority is a special health authority charged with identifying, investigating and preventing fraud and other economic crime cross the NHS in England. It is focused entirely on counter fraud work and is independent from other NHS bodies and directly accountable to the Department of Health.

The purpose of the NHS Counter Fraud Authority is to lead the NHS in protecting its resources by using intelligence to understand the nature of fraud risks, investigate serious and complex fraud, reduce its impact and drive improvements.

What should I do if I suspect an offence is taking place?

If you suspect an offence is taking place you must:

  • Make a note of your concerns in as much detail as possible
  • Note all relevant details, such as what was said, the date and time, names of all parties involved, or a description of individuals involved
  • If legal to do so, keep a record or copy of any documentation that arouses your suspicion
  • Report your concerns immediately, as any delay might cause the CCG to suffer further financial loss
  • You can report your concerns directly to the anti-fraud team - see contact details above.

Do not:

  • Investigate it yourself, as all evidence must be gathered in a legally admissible manner
  • Confront the individual
  • Convey your suspicions to anyone other than those with proper authority to investigate
  • Do nothing!

Examples of types of fraud in the NHS include:

  • Managers and staff: Alteration of timesheets or travel expenses; abuse of NHS equipment; working elsewhere whilst sick; misappropriation of funds; making false statements on application forms and references
  • NHS clinicians: Alterations of records; false claims for work; creating "ghost" patients; private work on NHS time; working elsewhere whilst sick
  • NHS patients: Prescription fraud (altering of prescriptions, wrongfully claiming exemption from fees); multi-registration patients; false travel expense claims; overseas visitors claiming to be eligible for NHS services
  • Contractors and suppliers: Submission of bogus invoices; price fixing.