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Countering Fraud in the NHS

Countering Fraud in the NHS

Welcome to the Counter Fraud section which contains important information, guidance and advice for the Trust’s staff on countering fraud in the NHS. Whilst the majority of people who work in and use the NHS are honest, there is a minority who will seek to defraud the NHS of its valuable resources.

One of the basic principles of the NHS is the proper use of public funds. It is therefore important that all staff working in the public sector are aware of the risk of fraud, corruption, theft, and other illegal acts involving dishonesty. The aim is to protect NHS staff and resources from activities that would otherwise undermine their effectiveness and their ability to meet the needs of patients and professionals. Ultimately, this helps to ensure the proper use of valuable NHS resources.

All NHS staff have a responsibility to safeguard the assets of the NHS, and to report any suspicion of fraud, corruption, or other wrongdoing at the earliest opportunity.

 

What is Fraud?

For practical purposes fraud may be defined as the use of deception with the intention of obtaining an advantage, avoiding an obligation or causing loss to another party. Generally, the term fraud is used to describe such acts as deception, bribery, forgery, extortion, corruption, theft, conspiracy, embezzlement, misappropriation, false representation, concealment of material facts and collusion.

 

What sort of things might be considered fraudulent?

Examples of what might constitute fraud include:

  • Falsely claiming to be sick
  • Claiming for hours not worked
  • Doing external work during NHS time
  • Falsifying expense claims
  • Falsifying records to steal NHS property
  • Failing to declare criminal convictions 

 

What can be done?

The NHS has a zero-tolerance approach to fraud. Fraudsters will be prosecuted where there is sufficient evidence to support a case. Criminal and Civil powers will be used to recover lost monies from fraudsters. Disciplinary action will normally result in dismissal, and for professionals with expulsion from their professional body.

Example of fraud committed by a patient

A patient falsely claimed over £2,500 a year in travel expenses to an outpatient clinic. 

Example of fraud committed by a Doctor

The dispensing GP who submitted false claims to the Prescription Pricing Authority over a six year period, amounting to over £676,000. Sentenced to four-year imprisonment and assets to the value of £800,000 confiscated.