Countering Fraud in the NHS
Fraud against the NHS means that the money intended for patient care, and funded by the taxpayer, ends up in the pockets of those who did not legitimately earn it. It means fewer resources are available to be spent on frontline health services such as patient care, health care facilities, doctors, nurses and other staff.
Fraud, bribery, corruption and other illegal acts committed to obtain financial or professional gain, cost the NHS billions of pounds every year. In 2016-17 it was estimated that the cost to the NHS was around £1.25 billion per annum, as per the NHS Counter Fraud Authority, who assess that to be enough money to pay for over 40,000 staff nurses or to purchase over 5,000 frontline ambulances.
NHS Barnet Clinical Commissioning Group is committed to maintaining an honest, open and well-intentioned approach to best fulfil the objectives of the NHS. This means the CCG operate a zero-tolerance approach to fraud and bribery. Such conduct, at any level, is unacceptable.
The CCG ensures that there are effective controls in place throughout the organisation, including stringent policies and internal systems to prevent and detect bribery, in accordance with the Bribery Act 2010, and to counter fraud by ensuring compliance with the NHS Counter Fraud Authority Standards for Commissioners.
What is fraud?
Fraud happens when someone makes a deliberate attempt to dishonestly make a gain for themselves or another, or cause a loss to another. This may include any person who makes a false representation or dishonestly fails to disclose to another person information which they are under a legal duty to disclose, or commits fraud by abuse of position, including any offence as defined in the Fraud Act 2006. Examples of the three main fraud offences are provided below. Further information can be found in our Anti-Fraud Policy.
This is the most common type of fraud investigated within the NHS. This normally involves a false declaration being made, such as working whilst sick. The staff member is being paid sick pay by the CCG, but is then being paid for secondary employment too, whether that is in the NHS or otherwise.
Failure to disclose
This could be relating to any information where there is a legal duty to disclose. For example, failing to disclose a criminal record or anything that could affect your DBS checks.
Abuse of position
This is when someone abuses their position of authority against another person or their employer, for personal or financial gain, or to cause loss to another. Essentially, those who know how to use the systems, but ultimately abuse them too.
What is bribery?
Bribery refers to the giving or receiving of an inducement, in return for a person committing an improper function. It is an offence to give or receive a bribe, or even offer or accept, even if the briber is never paid. A bribe is any inducement, financial or not, to encourage or reward someone to do something they should not do. The four main offences under the Bribery Act 2010 are detailed below. Further information can be found in our Bribery Policy.
- Give a bribe
- Negligently fail to prevent a bribe
- Receive a bribe
- Bribe a foreign public official
National Fraud Initiative 2018/19
We are required by law to protect the public funds we administer. We may share information provided with other bodies responsible for auditing or administering public funds, in order to prevent and detect fraud. The Cabinet Office is responsible for carrying out data matching exercises.
Data matching involves comparing computer records held by one body against other computer records held by the same or another body to see how far they match. This is usually personal information. Computerised data matching allows potentially fraudulent claims and payments to be identified. Where a match is found it may indicate that there is an inconsistency which requires further investigation. No assumption can be made as to whether there is fraud, error or other explanation until an investigation is carried out.
We participate in the Cabinet Office's National Fraud Initiative: a data matching exercise to assist in the prevention and detection of fraud – see guidance https://www.gov.uk/guidance/taking-part-in-national-fraud-initiative
The processing of data by the Cabinet Office in a data matching exercise is carried out with statutory authority under its powers in Part 6 of the Local Audit and Accountability Act 2014. It does not require the consent of the individuals concerned under data protection legislation or the General Data Protection Regulation (GDPR). For further information on the reasons why it matches particular information, see https://www.gov.uk/government/publications/fair-processing-national-fraud-initiative/fair-processing-level-3-full-text
For further information on data matching at the North Central London Clinical Commissioning Group please contact Erin Sims, Counter Fraud Specialist, by emailing firstname.lastname@example.org . Further information on how the NFI has assisted the NHS and other public sector organisations can also be found at https://www.gov.uk/government/publications/national-fraud-initiative-case-studies/nfi-public-sector-case-studies
What can I do?
The first steps are being aware of the risk and remaining vigilant. You should also know how to report any suspicions or concerns you may have about fraud and/or bribery.
NHS Barnet Clinical Commissioning Group contracts RSM to provide the CCG’s Counter Fraud service.
Alternatively, you can call the NHS Counter Fraud Authority’s 24-hour reporting line anonymously on 0800 028 4060, or confidentially online at www.cfa.nhs.uk/reportfraud. More information about the NHS Counter Fraud Authority and examples of recent cases.