National Fraud Initiative

This authority 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, in order to prevent and detect fraud. The Audit Commission appoints the auditor to audit the accounts of this authority. It is also 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 indicates 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 Audit Commission currently requires us to participate in a data matching exercise to assist in the prevention and detection of fraud. We are required to provide particular sets of data to the Audit Commission for matching for each exercise, and these are set out in the Audit Commission’s guidance

The use of data by the Audit Commission in a data matching exercise is carried out with statutory authority under its powers in Part 2A of the Audit Commission Act 1998. It does not require the consent of the individuals concerned under the Data Protection Act 1998.

Data matching by the Audit Commission is subject to a Code of Practice For further information on the Audit Commission’s legal powers and the reasons why it matches particular information, see  www.audit-commission.gov.uk

National Arrangements

The Counter Fraud and Security Management Service (CFSMS) has responsibility for all policy and operational matters relating to the prevention, detection and investigation of fraud and corruption, and the management of security in the National Health Service. The creation of the CFSMS on 1 January 2003, follows the successes of the NHS Counter Fraud Service (NHS CFS) which was established in September 1998, with the remit of tackling all losses to fraud and corruption in the NHS. The potential NHS savings from completed Counter Fraud Service Investigations for 2008/09 was £9,946,030, taking the total savings since 2004/05 to £48,332,216. Further information is available on www.nhsbsa.nhs.uk This includes full details of the national performance statistics and examples of proven cases of fraud.

NHS Counter Fraud Service facts

  • Around 375 professionally-trained and accredited Local Counter Fraud Specialists are in place covering every health body in England and Wales. They are supported nationally and regionally by the NHS Counter Fraud Service.
  • The NHS Counter Fraud Service was established to tackle fraud and corruption throughout the NHS, whether it involves professionals, staff, patients or contractors, in order to create a lasting anti-fraud culture.
  • The NHS Counter Fraud Service works with trusts, the police and the CPS to stop offenders and send the message that crimes against the NHS and its staff will not be tolerated.
  • The value of NHS fraud and unlawful action identified in 2008/09 was £16,259,536

Counter Fraud

What is fraud?

The Fraud Act 2006 defines fraud as:

  • Dishonestly making a false representation - ie: falsifying a timesheet
  • Dishonestly failing to disclose information - ie: failing to declare previous convictions
  • Fraud by Abuse of Position - ie: a member of staff fraudulently obtaining money from a service user

Common examples of fraud uncovered within the NHS include:

  • Employees using forged passports and counterfeit documentation to obtain NHS employment
  • Staff falsifying or inflating timesheets and mileage claims
  • Applicants falsifying information on job application forms
  • Contractors invoicing for goods or services not ordered and/or provided

Is fraud a problem in the NHS?

Fraud is estimated to cost the NHS between 5–8% of it’s total national budget. These resources could be better spent on patient care.
What should I do if I suspect a fraud?

  • Note down all relevant details – ‘who’, ‘what’, ‘where’ ‘when’ and ‘how’.
  • Contact the Local Counter Fraud Specialist (LCFS), Director of Finance, or the National Fraud and Corruption Reporting Hotline.

Is there anything I shouldn’t do? DON’T

  • Investigate the matter yourself
  • Alert the individuals you suspect of your suspicions
  • Tell colleagues about your suspicions

Reporting Your Suspicions

If you have any concerns or suspicions of any activity you believe may be fraudulent within the Trust, then it is important that you contact the following below. Any information received will be treated with utmost discretion and you can remain anonymous if you wish.

  • Liz O'Reilly (LCFS) 01924 816098
  • Email: liz.oreilly@nhs.net
  • National Fraud Reporting Hotline 0800 0284060
  • Carol Stubley (Director of Finance) 01274 363508

Local Arrangements

Within each NHS organisation a nominated and accredited Local Counter Fraud Specialist (LCFS) is in place. This individual is responsible for ensuring that arrangements for countering fraud and corruption are in place, following the Secretary of State for Health directions. The directions, issued in 2004, state the responsibilities of each organisation to investigate fraud and promote an anti-fraud culture. The nominated LCFS for Bradford District Care Trust is Liz O'Reilly. Liz has undertaken specific training in respect of countering fraud, and has gained accreditation in this field.