Tackling fraud in the NHS

What is fraud and how does it impact the NHS

Fraud is committed when a person deliberately makes a dishonest representation in order to make a gain or to cause a loss to someone else. For example, if someone stated on their expenses claim that they had travelled 50 miles when really they had only travelled 10, this would be fraud. The person has made a false representation in order to make a gain.
Fraud comes in many different forms. The NHS Counter Fraud Authority (NHSCFA) has produced a reference guide which provides loads of different examples of how the NHS can be affected by fraud – you can find the full guide here. At the latest estimate, it is believed that the NHS loses over £1.2 billion a year to fraud. NHS fraud diverts public funds away from the services that we all pay for, and into the pockets of dishonest people.

The role of the LCFS

NHS Hull Clinical Commissioning Group has a dedicated Local Counter Fraud Specialist (LCFS). The role of the LCFS has several strands, and is overseen by the Chief Finance Officer at a local level, and by the NHSCFA at a national level. Your LCFS will ensure your employer is meeting the standards set by the NHSCFA that policies and procedures are fraud proof, and that staff are encouraged and enabled to learn more about NHS fraud. The LCFS is also responsible for investigating allegations of fraud, bribery and corruption. Your LCFS is here to help. If you have concerns about fraud affecting the NHS, please do get in touch with them for advice.

Your Local Counter Fraud Specialist

- Name Nikki Cooper
- Contact email nikki.cooper1@nhs.net
- Contact number 01482 866800/07872 988939

Reporting fraud

If you have concerns about fraud you can report it through the following channels:
- Directly to your LCFS using their contact details listed above
- Directly to the Chief Finance Officer, Emma Sayner
- By contacting the NHSCFA reporting line on 0800 028 4060
- By completing an online report: https://reportfraud.cfa.nhs.uk/

All reports will be dealt with confidentially. Please note that the best route for reporting is to speak to your LCFS. If you would prefer to make an anonymous report via the NHSCFA hotline or web form, please provide as much detail as possible as the LCFS will not be able to get back in touch with you to ask for any further information or clarification about your concerns.

Examples of types of fraud

Patient Travel Expenses – a patient in receipt of qualifying benefits may claim travel expenses for secondary care appointments. If the person submits claims for additional journeys that they didn’t actually take, this would be fraud.
Mandate Fraud – a fraudster contacts an NHS finance team pretending to be a genuine supplier. They request that the suppliers’ bank details are updated, and the next payment made to the supplier is diverted into the fraudster’s bank account.
Working Whilst Sick – a person is signed off sick from their NHS role but then works elsewhere during their sick leave.

How to arrange a presentation/awareness session

- One of the simplest ways you can help to counter fraud in the NHS is to organise a fraud awareness presentation for your team. We are always happy to speak to different teams across the NHS. We can tailor our presentations to cover the specific fraud risks you are most likely to encounter, and will fit around your team’s availability. If you would like to arrange a session, please contact Nikki using her contact details above.

A list of the training sessions we can offer

- Fraud Awareness 30 minutes – suitable for all departments and staff groups
- Fraud Awareness 60 minutes – a more in depth look at fraud in the NHS, suitable for all staff
- Recruitment Fraud Awareness – for HR teams and recruiting managers
- Procurement Fraud Awareness – Procurement/Finance Teams
- Mandate Fraud and Phishing Refresher – suitable for all staff but most applicable to finance teams
- We would be happy to deliver any other bespoke training for you, or to pop along to a team meeting for an informal chat. We are able to offer training remotely via Microsoft Teams. Please contact your LCFS to discuss any training needs and we would be happy to help

The role of the fraud champion & who the Fraud Champion is

- The role of the Fraud Champion is to raise awareness of fraud, to understand the risks posed by fraud, and to understand best practice in countering fraud. The Fraud Champion and the LCFS work closely to ensure that efforts are coordinated and effective. The Fraud Champion for Hull CCG is:
  - Name Danny Storr, Deputy Chief Finance Officer
  - Contact email d.storr@nhs.net