Countering Fraud & Corruption in the NHS

Countering Fraud & Corruption in the NHS E-Learning Module NHS NOTTINGHAMSHIRE COUNTY MARCH 2011 next >>

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification How this module works Click on the buttons at the bottom right of each screen to navigate through this e-learning module. The buttons represent: Next slide Previous slide Go back to the beginning of the section Go straight to the section questions Press the ESC key on your keyboard to stop the presentation at any time.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification The aims of this module are: • To explain what constitutes fraud and corruption in the NHS and what you • should do if you identify suspicions; • To explain the NHS Counter Fraud Strategy; and • To explain the role of the Local Counter Fraud Specialist (LCFS) and how • they can help you and the Trust deal with the problem of fraud. It will take about 20 minutes to complete the whole module.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Why do I need to know about the Counter Fraud Service and go through this module? Any member of staff could potentially become aware of a practice that they think is wrong but they may not know who to talk to about it. This module will give some basic advice on the steps to follow. HOWEVER… pleasedon’t think that fraud is rife in this Trust as the indications are that it is not. This module is intended to promote awareness of the potential for fraud and corruption, so that you know what to do and who to contact if you ever become aware of a suspicion.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification The NHS Counter Fraud Service exists to minimise losses through FRAUD & CORRUPTION Every year millions of pounds of public money are at risk to fraud and corruption in the NHS. A small minority of people feel that it is acceptable, by their criminal behaviour, to deprive the NHS of resources which would otherwise be used to provide patient services.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification The NHS Counter Fraud Strategy • The NHS Counter Fraud Service was established in 1998 • The Chief Executive and Director of Finance are jointly responsible for ensuring compliance with Secretary of State Directions (or in the case of Foundation Trusts, the Independent Regulator’s License) • Every Health Body in England & Wales must nominate an Accredited Local Counter Fraud Specialist (LCFS) to undertake counter fraud work in 7 generic areas of activity AIM: • To reduce fraud within the NHS to an absolute minimum and hold it permanently at that level to free up resources for better patient care

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification The Counter Fraud Structure Secretary of State NHS Business Service Authority NHS Protect Area Counter Fraud Specialist Director of Finance/Chief Executive Local Counter Fraud Specialist Trust employees, patients, visitors and contractors

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Review Your Learning What have you learnt from this module so far? Here are a few questions…

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Who set up the NHS Counter Fraud Service? Choose your answer The Trust’s Audit Committee because they are worried about the level of fraud at this Trust. The Secretary of State so that mechanisms can be established to reduce NHS fraud nationally.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Who set up the NHS Counter Fraud Service? The Secretary of State so that mechanisms can be established to reduce NHS Fraud nationally.  Yes, that’s right! The Secretary of State directions issued in 1999 set in motion the NHS Counter Fraud Initiative that all health bodies must adhere to.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Who set up the NHS Counter Fraud Service? The Trust’s Audit Committee because they are worried about the level of fraud at this Trust.  No, that’s the wrong answer, please try again Every health body has to comply with Secretary of State Directions or in the case of Foundation Trusts, the Independent Regulators License requirements. Compliance with the directions in no way implies that fraud is rife at the Trust or that the Audit Committee and the Director of Finance are concerned that fraud is a particular problem within the organisation.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Who is responsible for ensuring the directions are followed at this Trust? Choose your answer The Local Counter Fraud Specialist The Director of Finance & Chief Executive The Secretary of State through NHS Protect

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Who is responsible for ensuring the directions are followed at this Trust?  No, that’s the wrong answer, please try again The Local Counter Fraud Specialist carries out work to assist the Trust’s compliance with Secretary of State Directions/the Independent Regulators License requirements. NHS Protect undertakes assessments of the adequacy of compliance with directions within the Trust.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Who is responsible for ensuring the directions are followed at this Trust? The Director of Finance & Chief Executive.  Yes, that’s right! The Director of Finance and Chief Executive are responsible for monitoring compliance with Secretary of State Directions/the Independent Regulators License requirements but will be guided by reports received from the Local Counter Fraud Specialist and NHS Protect.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Is the Counter Fraud Service effective? Nationally… Between 1999 and 2010: In 2009-10 alone: • £4,182,758in potential savingswere identified; • 2626investigations were concluded; • there were 150 successful prosecutions; and • 583 civil anddisciplinary sanctions were applied. • More than£65 million was recovered; • Approximately £824 million was saved; and • There were 616successful prosecutions.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Is the Counter Fraud Service effective? During the 2 year period ending 31st March 2010, East Midlands NHS Local Counter Fraud Services: • Received 268referrals • Brought 236 investigations to conclusion • Identified 107 system weaknesses • Obtained 21 criminal convictions, 54 disciplinary sanctions and 12 awards by civil action • Identified fraud losses totalling £1.24m (£1m recoverable) • Brought the Counter Fraud message to almost 24,000 NHS staff

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification How much money, diverted from the NHS through Fraud, has already been recovered and put back into patient care? Choose your answer £3 million has been recovered to date. £15 million has been recovered to date. £65 million has been recovered to date.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification How much money, diverted from the NHS through Fraud, has already been recovered and put back into patient care?  No, that’s the wrong answer, please try again

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification How much money, diverted from the NHS through Fraud, has already been recovered and put back into patient care?  Yes, that’s right! Over £65 million has been recovered to date, but this amount is increasing as new cases are being investigated.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification What is Fraud? In the simplest of terms, Fraud is theft with an element of deception involved. The most common offences under the Fraud Act 2006 are: Fraud by false representation – e.g. submission of false timesheets for shifts not worked Fraud by failing to disclose – e.g. failing to declare criminal convictions when applying for NHS employment Fraud by abuse of position – e.g. a person in a position of trust using their position to commit fraud (Some fraud offences, committed before 15th January 2007, continue to be prosecuted under the Theft Acts)

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification What is Corruption? Corruption is defined as the offering, giving, soliciting or acceptance of inducements which may influence a person’s actions. For example a supplier making a payment to a staff member to secure a contract or to supply goods or services in excess of actual requirements. The Trust may, as a result, fail to achieve value for money or pay for goods not required.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Examples of potential Fraud & Corruption in the NHS • Submission of false timesheets for shifts not worked; • Employees claiming NHS sick pay when actually working for another employer; • False declarations of employment history/qualifications in order to gain employment; • Submission of false/excessive expense claims; • Submission of false quotes, invoices or receipts in order to obtain financial reimbursement (staff & suppliers/contractors); • Contractors claiming for goods/services not supplied;

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Examples of potential Fraud & Corruption in the NHS • Diversion of charitable donations for personal benefit; • Failing to report receipt of salary (or other) overpayment; • Employees conducting personal/private business in work time; • Unauthorised use of NHS equipment /facilities for personal gain; • Acceptance of gifts and inducements for third party advantage; • Patients falsely claiming entitlement to NHS treatment/services; • Patients falsely claiming exemption from NHS charges.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Who might commit Fraud? • Staff • Patients • Contractors • Suppliers • Visitors Anyone

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Do you, as a Trust employee, have a part to play in countering NHS Fraud? Choose your answer Yes, I do. No, I have no involvement in this.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Do you, as a Trust employee, have a part to play in countering NHS Fraud?  No, that’s the wrong answer, please try again Regardless of your job role, you may come across fraud in the course of your normal duties. If you do, your responsibilities are outlined in the Trust’s Fraud and Corruption Policy. You must report any suspected fraud to the Local Counter Fraud Specialist so that an investigation can take place. Failure to do this could result in the fraud remaining undetected and money continuing to be fraudulently diverted from patient care.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Do you, as a Trust employee, have a part to play in countering NHS Fraud?  Yes, that’s right! As a Trust employee, if you think someone is acting fraudulently, then you must report this to the Local Counter Fraud Specialist, in accordance with the Trust Fraud and Corruption Policy.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Which of the following scenarios could be considered fraudulent? Choose your answer Staff adding shifts or hours to a timesheet that they know have not been worked. Staff retaining a payment with their salary that they know they are not entitled to. Staff working elsewhere while claiming NHS sick pay. All of the above.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Which of the following scenarios could be considered fraudulent?  Yes, that’s right! All the options listed are potential frauds.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Which of the following scenarios could be considered fraudulent?  Yes, that’s right, but … The answer you chose is a potential fraud, but so are the other three. The correct answer is, therefore, all of the above.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification What do I do if I think a Fraud is occurring?  • Don’t investigate the matter yourself or report it to your manager – this may compromise any potential prosecution. • Don’t undertake any surveillance – this will breach the Human Rights Act.   Do make a note of your suspicions. Sign the note, date it and keep it safe. Do try to secure or copy documents you believe to be suspicious. Do contact your LCFS on 01332 868931. (Further reporting methods can be found on the Trust’s Counter Fraud intranet page).  

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification What if I am wrong? • Never be afraid to raise your suspicions directly with your Local Counter Fraud Specialist even though you may be wrong…You could be right! • There will be no ramifications for raising an issue you believe to be fraud, regardless of how the investigation is concluded, as long as your referral was raised in good faith. • If you are uncertain of whether a referral is needed, you should contact your Local Counter Fraud Specialist anyway for advice. • The person investigated will not be disadvantaged if the investigation undertaken does not uncover any fraudulent activity.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification What if I am right? • The LCFS will have validated the suspicions and uncovered evidence. • The person under investigation will have explained their actions at a formal interview under caution. (Whatever is said can be used in a criminal prosecution). • A decision will be reached regarding appropriate sanctions to be pursued. • Any loss will be calculated and a decision will be made regarding appropriate recovery action.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification How do I contact my Local Counter Fraud Specialist? Your LCFS is Penny Gee • 01332 868931 • penny.gee@derwentsharedservices.nhs.uk • C/O Internal Audit, Laurie House, Colyear Street, Derby, DE1 1LJ • You may also call the National NHS Fraud and Corruption Reporting Line (open 8am – 6pm, freephone 0800 028 40 60)or report on-line at www.reportnhsfraud.nhs.uk

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Can I report my suspicions anonymously? Yes, and anonymous referrals will be investigated, however it may hinder any investigation if we are unable to contact you in case we need further information. Even if you only give a contact reference and telephone number, this may help with the investigation as initial enquiries might prove inconclusive and we may therefore need to come back to you to see if you have any further information which might help us progress the investigation fully. If you do give us minimal contact details these will not be used to identify you.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification What is a Local Counter Fraud Specialist? This person is specially trained to: • Promote fraud awareness within the Trust; • Prevent and detect fraud; • Conduct professional fraud investigations; • Answer concerns and queries; and • Liaise with the Director of Finance and NHS Protect

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification The Role of the LCFS • The creation of an Anti-Fraud culture; • Maximum Deterrence of Fraud; • Successful Prevention of Fraud which cannot be deterred; • Prompt Detection of Fraud which cannot be prevented; • Professional Investigation of detected Fraud; • Ensuring effective Sanctions are applied against those who commit Fraud; • Ensuring effective Redress is sought where financial losses are identified.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Can anyone investigate Fraud? (such as a line manager or a Human Resources Officer) NO The Secretary of State Directions on NHS fraud clearly state that only a nominated and accredited Local Counter Fraud Specialist can undertake fraud investigations for each Health Body. This is to ensure that legislation governing criminal investigations (including the Human Rights Act and Data Protection Act) is not breached and as a consequence, that any potential criminal prosecution is not compromised. However… The LCFS works very closely with Human Resources whenever a member of staff is under investigation.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification What sanctions might be applied to people who commit Fraud? There are three courses of action that would be considered where fraud has been identified. Any one, or a combination of, these could be used: • Criminal prosecution or a Police caution (resulting in a criminal record); • Civil proceedings (including County Court orders) to recover financial losses; • Disciplinary proceedings (including action taken by a professional body).

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Who decides which sanction, or sanctions, are to be used? This will generally be a decision made jointly by the LCFS, Director of Finance, Area Counter Fraud Specialist and the Director of NHS Protect, taking account of legal advice. Serious cases involving employees may be pursued via both criminal and civil investigations, which may also result in internal and external disciplinary action. Where financial losses to the NHS are identified during the course of an investigation, recommendations are made by the LCFS to ensure that financial redress may be obtained from the offender.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Who can investigate a potential fraud within this Trust? Choose your answer Line Manager / Directorate Manager Director of Finance or Finance staff Director of Human Resources or Human Resources staff Local Counter Fraud Specialist

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Who can investigate a potential fraud within this Trust?  No, that’s the wrong answer, please try again Only the Local Counter Fraud Specialist can investigate any potential fraud within the Trust.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification Who can investigate a potential fraud within this Trust?  Yes, that’s right! If any other staff investigate fraud, it would be contrary to the Secretary of State Directions and could compromise any criminal proceedings that the Trust may wish to take once fraud has been proven. Cases must be referred directly to the Local Counter Fraud Specialist (not via line management).

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification You have evidence of Fraud. What do you do? Choose your answer You go out of your way to watch the person to catch them in the act. You then confront them with the evidence. You make an immediate note of everything you’ve seen and then contact the Local Counter Fraud Specialist.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification You have evidence of Fraud. What do you do?  No, that’s the wrong answer, please try again By going out of your way to watch someone you may be contravening the Human Rights Act and/or the Regulation of Investigatory Powers Act 2000. This could compromise any subsequent criminal case. Also an action could be brought against the Trust as a consequence of a member of its staff acting in this manner.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification You have evidence of Fraud. What do you do?  Yes, that’s right! Make a detailed note, sign and date it, then contact your Local Counter Fraud Specialist for advice on 01332 868931.

EAST MIDLANDS LOCAL COUNTER FRAUD SERVICES INTERNAL AUDIT CONSULTANCY IT AUDIT & FORENSICS COUNTER FRAUD SECURITY MANAGEMENT Post Payment Verification You think you know of a Fraud being carried out but you have no evidence. What do you do? Choose your answer Don’t tell anyone because you could be wrong. Contact your Local Counter Fraud Specialist and ask for advice. Make it known to the person you are concerned about that you know what they are doing.

Countering Fraud & Corruption in the NHS