Tackling Fraud in the NHS

 In Medical/Pharmaceutical Transcription

Playing our part in tackling NHS fraud

NHS fraud costs the taxpayer more than £5 billion each year, according to the ex-head of the NHS Anti-Fraud department in a BBC Panorama report, with an additional £2 billion apparently ‘lost’ due to errors in accounting and other financial processes.

While most people working within the NHS are decent, honest and hardworking, there are those (a small minority) who divert valuable resources from the NHS for their own personal gain through fraudulent activities. There are various different types of fraud committed against the NHS. However, the end result is the same – a loss of valuable NHS resources – and a hit taken by UK taxpayers who finance the NHS.

Types of NHS fraud

Fraud against the NHS can take various forms, and might be carried out by either individuals or organisations. For example, NHS staff and other associated professionals charging for services which, in fact, they did not provide, or overcharging for their services and pocketing the difference. External entities, such as suppliers and contractors, might also falsely invoice for goods or services – and pocket money to which they really have no entitlement. NHS fraud cases can be small-scale or on a much larger and more organised level.

Combating NHS fraud

The body responsible for investigating such fraud cases is the NHS Counter Fraud Service, which has an annual budget in excess of £100 billion to tackle the problem of fraud within the NHS. It has Regional Counter Fraud Specialists throughout the country who deal with investigating fraud cases. The value of cases which these investigators deal with can range from £15,000 to £75,000.

Fraud cases which deal with lower-value amounts are normally managed by Local Counter Fraud Specialists, who are typically based within local health bodies, but supported by the NHS Counter Fraud Service. Large-scale fraud cases, typically those involving more than £75,000 as well as cross-regional fraud cases, are dealt with by the NHS Counter Fraud Service Operational Support Team, which is specially trained in surveillance techniques.

Methods and techniques used to uncover NHS fraud

NHS fraud investigations make use of a variety of methods and techniques in order to gather data, information and supporting evidence for any case. These can include relevant work-related documents, statements from those allegedly accused of improper conduct, witness statements, and recorded interviews, which are subsequently transcribed for use in hearings, tribunals, or court.

There are more than 300 NHS Counter Fraud Specialists located throughout England and Wales. These dedicated professionals prioritise establishing the facts in any reported fraud case. Their primary objective is to get to the truth of the matter as quickly as possible. The NHS Counter Fraud Service oversees these following areas:
• Counter fraud policy and processes.
• Provision of intelligence to target areas for action.
• Evaluation of the scale and nature of fraud within the NHS.
• Establishment and oversight of practices and standards related to counter fraud work.

The activities encompassed by the Counter Fraud Service are wide-ranging, from the issue of penalty notices, in cases where patients have made fraudulent prescription charge claims to multimillion pound cases against pharmaceutical giants in relation to price-fixing.

Key characteristics of all NHS fraud investigations include confidentiality, integrity, and precise and accurate documenting and reporting of the facts of each case for consideration by the respective authorities.

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