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.
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
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.
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.
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.