Fraud

The information below provides details of what fraud and bribery are, as well as examples of the types of fraud that can occur within the NHS. It also details what action should be taken should a suspicion of fraud, bribery or corruption arise.

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 2018-19 it was estimated that the cost to the NHS was around £1.21 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.

The CCG 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 requirements to meet Government Functions Standard GovS013: Counter Fraud. 

RSM currently provides your Local Counter Fraud Specialist (LCFS) and the role of the LCFS is to implement the NHS Counter Fraud strategy within the organisation and to investigate professionally, any suspicions of fraud or bribery that may arise.

A message from the Director of Finance:

The CCG has a zero-tolerance approach towards fraud and bribery and will take action against those who commit fraud.  There is material available on our pages to help raise awareness and education of fraud within the NHS to help recognise it; report it; and  help prevent it.  We have a team of Counter Fraud Specialists who are happy to meet with individual staff members; attend team meetings; conduct workshops; and deliver awareness presentations.

If you have any concerns in relation to fraud or bribery at Oxfordshire Clinical Commissioning Group, or would like to know more, please take the time to view the Counter Fraud and Bribery Policy, Counter Fraud information below or contact your Local Counter Fraud Specialist directly.  Alternatively, you can report concerns anonymously to the NHS Fraud and Corruption reporting Line 0800 0284060 or online at https://cfa.nhs.uk/reportfraud  

What is fraud?
Fraud happens when someone makes a deliberate attempt to dishonestly make a gain for themselves or another, or cause a loss, or risk of 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.

Fraud by false representation- This is the most common type of fraud investigated within the NHS. This normally involves a false declaration being made, such as working elsewhere whilst on sickness absence from your substantive post. The staff member has made a representation that they are too sick to work, but is then undertaking work elsewhere, whether that is in the NHS or otherwise.

Fraud by 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, anything that could affect your Disclosure and Barring Service (DBS) checks or your right to work status. 

Fraud by 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. For example, an individual in a management position uses their knowledge and authority to divert approved payments in to a bank account in their name.

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 three main offences under the Bribery Act 2010 most relevant to the NHS are:

• Giving a bribe- offering, promising or giving a bribe to another person to perform a relevant function or activity;
• Receiving a bribe- Requesting or agreeing to receive or accepting a bribe to perform a function or activity improperly; and
• Corporate offence- failure of a commercial organization to prevent bribery.

Some common forms of bribery include: cash, facilitation payments, gifts, hospitality, political donations, charitable contributions, enhanced commissions,  and employment of friends/ family.

Further information about fraud and bribery can be found in our Counter Fraud, Bribery and Corruption Policy and Response Plan. 

 

Data processing

This CCG is required by law to protect the public funds it administers. It may share information provided to it with other bodies responsible for auditing or administering public funds, or where undertaking a public function, in order to prevent and detect fraud.

 We participate in the Cabinet Office’s National Fraud Initiative: a data matching exercise to assist in the prevention and detection of fraud. We are required to provide particular sets of data to the Minister for the Cabinet Office for matching for each exercise.

 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.

 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), however the Cabinet Office set out how your data will be used and your rights here.

 For further information on data matching at this CCG please contact the Local Counter Fraud Specialist, Victoria Dutton; victoria.dutton@tiaa.co.uk or vdutton@nhs.net, telephone 07826 858 746.

 

Reporting concerns:
Anyone can report concerns of fraud and bribery within the NHS. Whether you are a member of the public, an NHS employee, a contractor, a supplier, from another government agency or someone else, your input can make a difference.  Counter Fraud provision is provided by TIAA for Buckinghamshire, Oxfordshire and Berkshire West CCGs.

Suspicions and concerns can be reported, in absolute confidence, to the CCG’s Local Counter Fraud Specialist:

Victoria Dutton

Telephone: 07826 858 746

Email: victoria.dutton@tiaa.co.uk or vdutton@nhs.net

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 can be found here. Concerns can also be raised with the CCG’s Director of Finance.

 

Please click on the links and documents provided for further information, examples and case studies of fraud within the NHS.