‘Fraud costs the NHS an estimated £1.21bn a year according to recent NHS Counter Fraud Authority estimations. Fraudsters continue to exploit opportunities by coming up with several novel ways to exploit the NHS.

Tackling fraud in the NHS needs to be high on everyone’s agenda, and everyone has a role to play in eradicating incidences of fraud in order to protect our NHS resource that supports vital front line clinical services.

This role is vital in driving this agenda forward and helping build and maintain a culture of vigilance and awareness across the Trust.’

Mersey Care NHS Foundation Trust has nominated its inaugural Counter Fraud Champion.

The new Counter Fraud Champion is Sally Proffitt- Associate Director of Finance

 

Sally Proffitt.jpg‘Fraud costs the NHS an estimated £1.2 bn a year according to recent NHS Counter Fraud Authority estimations. Fraudsters continue to exploit opportunities by coming up with several novel ways to exploit the NHS.

Tackling fraud in the NHS needs to be high on everyone’s agenda, and everyone has a role to play in eradicating incidences of fraud in order to protect our NHS resource that supports vital front line clinical services. This role is vital in driving this agenda forward and helping build and maintain a culture of vigilance and awareness across the Trust.’    

The NHS Counter Fraud Authority (NHSCFA) has for a period of time advocated for NHS organisations to nominate new Counter Fraud Champions to join the NHS counter fraud community.  It is also a core requirement promoted by the UK Government’s Counter Fraud Function, which works across all Government departments and agencies.

Since nominations to the role of NHS Counter Fraud Champions opened in December 2019, they have received over 200 nominations and appointments so far.

The role and duties of the Counter Fraud Champion include:

  • promoting awareness of fraud, bribery and corruption within the Trust.
  • understanding the threat posed by fraud, bribery, and corruption.
  • understanding best practice on counter fraud; and,
  • committing to promoting a zero-tolerance approach to fraud within the Trust.

Responsibility for investigating allegations of fraud, bribery and corruption, as well as accountability for delivering the organisation’s annual anti-fraud plan, remain firmly with the nominated Anti-Fraud Specialist.

The Counter Fraud Champion will work closely with the Anti-Fraud Specialist to ensure that the Trust remains fully committed to the maintenance of a counter-fraud, bribery and corruption culture, preventing and deterring it wherever possible, and holding to account those who are found to have committed offences, by pursuing the full range of available sanctions against them. 

For more information on how the Counter Fraud Champion and the Anti-Fraud Specialist will work together, please refer to the Anti-Fraud Specialist and Counter Fraud Champion Liaison and Joint Working Protocol.

Staff should still report any concerns of fraud, bribery and corruption to either the Anti-Fraud Specialist or the national Fraud and Corruption Reporting Line on 0800 028 40 60 (online at https://cfa.nhs.uk/reportfraud).

Mersey Care’s Anti-Fraud Specialist

Claire Smallman

0776 9304145

Claire.smallman@miaa.nhs.uk or clairesmallman@nhs.net  

Mersey Care Counter Fraud Champion

Sally Proffitt – Associate Director of Finance  

07876 643730

Sally.Proffitt@merseycare.nhs.uk

For more information on the role of the Counter Fraud Champion, please visit the NHSCFA website at  https://cfa.nhs.uk/fraud-prevention/NHS-counter-fraud-champion

Mandate fraud occurs when someone contacts an NHS organisation with a request to change a direct debit, standing order or bank transfer mandate, by purporting to be from a genuine supplier that regular payments are made to.

If the organisation accepts the fraudulent request, the payments are then diverted into the criminal's bank account. The genuine supplier details are usually obtained from a range of sources including corrupt staff, publicly announced contracts and online logs of supplier contracts.

False exemption claims: This is when patients declare that they are exempt from paying for prescriptions when they aren't

Overseas Visitors: This is when individuals visit this country specifically to gain free treatment from the NHS which they are not entitled to receive.

Contractors and Suppliers: Includes the submission of bogus invoices and fraudulent claims by appliance contractors.

Timesheet fraud: Staff members (permanent, bank or agency) createfalse overtime claims or add hours onto their timesheets to say that they have worked whenthey actually haven't.

Working whilst sick: This is when individuals state they are unfitfor work and then work somewhere else.

Travel/expenses fraud: Staff create false mileage/ travel/expensesclaims or inflate claims in order to obtain extra money from the Trust that they are notentitled to.

Failing to declare convictions: This is when staff do not declareconvictions when obtaining employment in the NHS or fail to tell us about them if they areconvicted whilst working for the Trust.

False qualifications / professional registration: This is when peopleclaim to possess qualifications they have not obtained or state that they are members of aprofessional body when they are not

The NHS Counter Fraud Authority (NHSCFA) has for a period of time advocated for NHS organisations to nominate new Counter Fraud Champions to join the NHS counter fraud community. It is also a core requirement promoted by the UK Government’s Counter Fraud Function, which works across all Government departments and agencies.

Since nominations to the role of NHS Counter Fraud Champions opened in December 2019, they have received over 200 nominations and appointments so far.

The role and duties of the Counter Fraud Champion include:

  • promoting awareness of fraud, bribery and corruption within the Trust
  • understanding the threat posed by fraud, bribery, and corruption
  • understanding best practice on counter fraud
  • committing to promoting a zero tolerance approach to fraud within the Trust.

Responsibility for investigating allegations of fraud, bribery and corruption, as well as accountability for delivering the organisation’s annual anti fraud plan, remain firmly with the nominated anti fraud specialist.

The Counter Fraud Champion will work closely with the Anti-Fraud Specialist to ensure that the Trust remains fully committed to the maintenance of a counter fraud, bribery and corruption culture, preventing and deterring it wherever possible, and holding to account those who are found to have committed offences, by pursuing the full range of available sanctions against them.

Staff should still report any concerns of fraud, bribery and corruption to either the Anti-Fraud Specialist or the national Fraud and Corruption Reporting Line on 0800 028 40 60 or online.

On a basic level, fraud is deception carried out for personal gain, usually for money. Fraud can also involve the abuse of a position of trust. By 'NHS fraud' we mean any fraud where the NHS is the victim.

For example, imagine if you work for an NHS organisation and make false claims for travel expenses. Your role involves frequent travel by car and each month you submit a form detailing your expenses, which the organisation then pays into your account. One day you decide to start inflating your expenses, claiming for more miles than you actually travelled in order to get more money.

This is an example of fraud (specifically, fraud by false representation) as you are tricking your employer into believing you incurred higher expenses than you actually did, in order to make a financial gain.

The vast majority of those who use, work in or otherwise interact with the NHS are honest. However, the small minority who commit fraud against the NHS includes a wide range of people,from patients and members of the public to NHS staff, from contractors and suppliers to organised crime groups.

When fraudsters target the NHS and succeed, this results in a loss of resources intended for patient care. We all bear the cost when the NHS loses money to fraud.

Bribery or corruption involves offering, promising or giving a payment or benefit-in-kind in orderto influence others to use their position in an improper way to gain an advantage.

If you suspect fraud, bribery or corruption - you MUST report it.

All NHS staff have responsibility to help prevent fraud by:

  • Declaring any secondary employment/private work undertaken to your manager

  • Declaring any outside Interests which could be seen to compromise your judgment, decisions or duties

  • Declaring any potential conflicts of interest - you are required to inform the Trust if you, your spouse, partner, relative, close friend or associate has an interest that may or does conflict with the business of the Trust

  • Declaring any gifts, hospitality or sponsorship. Be alert to when a gift, hospitality, or sponsorship could be interpreted as a 'bribe'

  • Ensuring timesheets/payments/mileage claims should be checked and accurate

  • Abiding by the Trust/NHS Code of Conduct

  • Reporting all suspicions or concerns of fraud, bribery or corruption.

Everyday £250,000 is lost an hour due to fraud in the NHS - the same as the cost for a fully kitted out ambulance!

That equates to around £2billion every year lost to fraud. Help us combat fraud and put money back into patient care. 

If you suspect fraud, bribery or corruption - report it immediately here.

clairesmall.jpgClaire Smallman, Anti Fraud Specialist

Claire is the Senior Anti Fraud and Investigations Manager of MIAA anti fraud services.

Claire is responsible for the oversight of all fraud, bribery and corruption investigations for MIAA client base.

Email: clairesmallman@nhs.net or claire.smallman@miaa.nhs.uk

Tel: 07769 304 145

Sally Proffitt, Counter Fraud Champion

Email: Sally.Proffitt@merseycare.nhs.uk

Tel: 07876 643 730

Report fraud now

Useful videos

Fraud in the NHS video

Working whilst off sick video

Cyber awareness video

Mersey Care's Director of Finance Bribery Statement