Fraud

What is fraud?

The main offences of fraud are currently contained within the Fraud Act 2006, which was implemented on 15 January 2007. Fraud is any deliberate intent to dishonestly deprive someone, or somebody (ie, the NHS) of money, goods or services through false representation (can be written, verbal or implied). For an offence of fraud to be committed, the perpetrator must have dishonest intent, and must intend to make a gain, cause a loss, or expose another to the risk of a loss.

Fraud by False Representation (Section 2 of the Fraud Act 2006)
Example: An individual lying on their application form that they have the right to work in the United Kingdom in order to obtain employment. In this instance the person has made a false representation in that they are legally allowed to work in the UK and have made gain for themselves.

Fraud by Failure to Disclose (Section 3 of the Fraud Act 2006)
Example: A person fails to mention on their job application that they lost their previous job due to a criminal conviction.

Fraud by Abuse of Position (Section 4 of the Fraud Act 2006)
Example: An employee creates patient records on the patient booking system for a family member who lives abroad to enable them to access NHS services free of charge. The maximum penalty that can be imposed for someone who has committed fraud is ten years imprisonment.

Examples of fraud

Professionals

Alteration of records; false claims for work; creation of "ghost patients"; private work on NHS time; working elsewhere during contracted hours and fraudulent claims for out-of-hours visits.
Example: A dentist was sentenced to two years' imprisonment for creating fictitious patients on his dental register and fraudulently claiming money for treating them on the NHS. The subject pleaded guilty to fraud and theft totaling £109,000. He submitted false claims to NHS Dental Services and deceived NHS patients into being treated and charged privately.

Managers and staff 

Submission of false time-sheets; working elsewhere whilst on sick leave; submission of false expense claims; providing false information on a CV or application form; failing to disclose criminal convictions; producing false qualification certificates; producing false identity or Home Office documents to obtain employment; knowingly authorising false time-sheets or expense claims; payroll fraud.
Example: A healthcare support worker who committed fraud amounting to more than £60,000 was sentenced to 21 months' imprisonment. She submitted entirely false bank time-sheets for two years after working only a handful of shifts. In total she was charged with 26 counts of fraud with 68 further offences taken into consideration.

Patients

Falsely claiming exemption for prescriptions; falsely obtaining NHS services free of charge and submission of false patient travel claims.
Example: The parents of a child that was a patient at a hospital submitted false travel claims to the cashiers' office for reimbursement. Each parent was sentenced to imprisonment.

Bribery Act 2010

The Bribery Act reforms the criminal law to provide a new, modern and comprehensive scheme of bribery offences that will enables courts and prosecutors to respond more effectively to bribery at home or abroad. The Bribery Bill received Royal Assent on 8 April 2010 and became enforceable on 1 July 2011. The Bribery Act applies to all individuals living in and corporates (irrespective to what happens to any profit) based or operating in the UK. The act covers all sorts of bribery, directly or indirectly, whether or not this involves a public official, in the UK or abroad. There are offences for individuals, a corporate offence for corporates and partnerships and penalties for non-compliance are serious.

What is a bribe?
A bribe is defined as a financial or other advantage. There is no minimum value; it can include cash, hospitality, a gift, a facilitation payment; it can be offered with the intention of inducing improper behaviour, or knowing acceptance would be improper. There are four offences under the Bribery Act:

• Giving (or offering) a bribe
• Receiving (or requesting) a bribe
• Negligently failing to prevent a bribe (corporate offence)
• Bribing a foreign public official

What are the penalties?

• A criminal prosecution carries a sentence of up to ten years imprisonment
• Organisations can receive an unlimited fine
• Disbarment from EU contract tenders
• Reputation is ruined by allegations of bribery and corruption 

There are six adequate procedures to which the Trust is responsible for adopting. All staff should be aware of the Trust's Anti-Bribery Policy and you should take your time to familiarise yourself with its content.  In conjunction with this, staff should familiarise themselves with the other related policies identified within the Anti-Bribery and Anti-Fraud Policy, such as the gifts, hospitality and declaration of interests, and whistle blowing. Staff could be held individually accountable for acting against these policies or the Act itself. This could lead to disciplinary and/or criminal investigation.

We are required by law to protect the public funds we administer. We may share information provided with other bodies responsible for auditing or administering public funds, in order to prevent and detect fraud. The Cabinet Office is 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 determine the extent of the match. This is usually personal information. Computerised data matching allows potentially fraudulent claims and payments to be identified. Where a match is found it may indicate 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.

We participate in the Cabinet Office's National Fraud Initiative: a data matching exercise to assist in the prevention and detection of fraud – see the guidance here.

The processing of data by the Cabinet Office in a data matching exercise is carried out with statutory authority under its powers in Part 6 of the Local Audit and Accountability Act 2014. It does not require the consent of the individuals concerned under data protection legislation or the General Data Protection Regulation (GDPR). For further information on the reasons why it matches particular information, click here.

For further information on data matching at Cambridgeshire and Peterborough NHS Foundation Trust please contact Julie McCarthy, Local Counter Fraud Specialist, by e-mailing julie.mccarthy@rsmuk.com. Further information on how the NFI has assisted the NHS and other public sector organisations can also be found here. 

https://www.gov.uk/government/publications/fair-processing-national-fraud-initiative/fair-processing-level-3-full-text

Reporting your concerns
Should you have a concern or suspicion relating to fraud or bribery within CPFT, or need advice, then you can contact the Trust's Local Counter Fraud Specialist (LCFS) using the contact details provided below.

NHS Anonymous Fraud Reporting Line
T: 0800 028 40 60.

Suspicions of fraud or bribery should only be reported to those with the appropriate authority to investigate fraud; suspicions of fraud should not be reported to a friend, colleague or your line manager. All referrals will be treated in confidence.

You can also contact the LCFS via telephone and/or e-mail.

If your contact details have been provided, the LCFS will contact you to acknowledge receipt of your concerns, as well as to establish any further information or facts, as required. These initial enquiries will establish whether there is sufficient evidence for a formal investigation to be initiated. The LCFS will explain if either the evidence is not sufficient to proceed with a formal investigation or whether it is not appropriate for the fraud investigation to be opened and handled by the LCFS.