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Countering Fraud, Bribery and Corruption

                                                                        

Countering Fraud, Bribery and Corruption

One of the fundamental principles of any NHS organisation is a commitment to ensuring that public funds are used appropriately. It is therefore vital that all staff understand what fraud, bribery and corruption are, how they affect the NHS and could affect the Clinical Commissioning Group, and what they should do if they suspect fraud, bribery or corruption has taken, or is taking, place.

The Clinical Commissioning Group has a Counter Fraud Specialist to whom all suspicions of fraud should be reported. All referrals will be professionally investigated and treated with the utmost confidentiality. The Clinical Commissioning Group’s Counter Fraud Specialist is:  

Chris Taylor, telephone number 01709 428717 or email address Christaylor2@nhs.net

If you think that you have identified fraud, bribery or corruption:      

 

Remember, everyone has a part to play in the fight against NHS fraud, bribery and corruption. If you suspect it, report it!

If you would not feel comfortable speaking to somebody connected to the Clinical Commissioning Group, there are a other ways in which you can share your concerns:

  1. Complete a Counter Fraud Referral Form here.
  2. Call the NHS Protect Fraud, Bribery and Corruption Reporting Line on 0800 028 40 60 (Monday to Friday, 8am to 6pm).

 

Fraudulent Times

The Clinical Commissioning Group’s Counter Fraud Specialist produces a quarterly newsletter, Fraudulent Times, which contains a variety of features including case studies, news about recent scams and advice about fraud prevention. The latest issue can be found here.

 

What are Fraud, Bribery and Corruption?

Fraud by an individual is a dishonest attempt to either make a gain for themselves, or expose another to a risk of loss (an offence is therefore committed simply by dishonestly trying to increase the risk of a loss to another even if the attempt fails and no loss actually arises).

The Fraud Act 2006 came into force on the 15 January 2007 and introduced the general offence of fraud. This is broken into three key sections:

  • Fraud by false representation;
  • Fraud by failing to disclose information; and
  • Fraud by abuse of position.

The Fraud Act also created new offences of;

  • Possession and making or supplying articles for use in fraud;
  • Fraudulent trading (sole traders); and
  • Obtaining services dishonestly.

The Bribery Act 2010 replaced the Prevention of Corruption Acts 1889-1916 and created two general offences of bribery:

  • Offering or giving a bribe to induce someone to behave, or to reward someone for behaving, improperly; and
  • Requesting or accepting a bribe in exchange for either acting improperly, or where the request or acceptance is itself improper.

A new corporate offence was also introduced:

  • Negligently failing by a company or limited liability partnership to prevent bribery being given or offered by an employee or agent on behalf of that organisation.

 

How do Fraud, Bribery and Corruption Affect the NHS?

Fraud, Bribery and Corruption can be found anywhere where money or valuable resources exist. With a total budget of over £110billion, the NHS is a prime target for fraudsters.

In 1998, in response to the risk posed by fraud, the NHS Counter Fraud Service was set up to oversee work to prevent and detect fraud within NHS systems and build a culture intolerant to fraud across NHS bodies. This organisation is now known as NHS Protect. The Clinical Commissioning Group’s Counter Fraud Specialist is accredited by NHS Protect to carry out work within commissioners and providers of NHS funded healthcare. NHS Protect has a public facing website which can be found here http://www.nhsbsa.nhs.uk/Protect.aspx.

Since 1998, frauds have been detected and investigated across the whole range of organisations commissioning or providing NHS funded healthcare. Frauds have been uncovered involving patients, contractors, GPs, Dentists, Optometrists, Pharmacists, Consultants, Directors; in fact in every area of staffing. In short, fraud can strike anywhere and be committed by anyone. In particular, during times of economic uncertainty and change, the risk of fraud has been proven to increase. This is especially pertinent in the NHS at this time.

How might Fraud, Bribery and Corruption affect the Clinical Commissioning Group?

As a new organisation, the Clinical Commissioning Group has taken responsibility for a number of areas, with a significant level of public funding at its disposal. A variety of frauds has occurred in Primary Care in recent years. In most cases, fraud has arisen because proper checks have not taken place and the controls that do exist have not been sufficiently robust. Examples of this can be seen in the case studies found here.

Detecting Fraud, Bribery and Corruption: What to look out for

The Clinical Commissioning Group’s responsibilities cover a number of areas and account for a large sum of public expenditure. While it is not possible to provide an exhaustive list of potential frauds which could affect the Clinical Commissioning Group, the following list does attempt to describe the indicators of potential fraud, bribery and corruption that you may encounter at work:

  • Data showing high performance compared to similar practices or organisations
  • Lack of evidence to support claims for payment or for additional services
  • Unexpected claims for payment
  • A change in behaviour or performance when management changes
  • Prescribing habits changing dependent on the pharmacy used by patients
  • Inability to explain rationale for prescribing or clinical decisions based on clinical need
  • Conflicts of interest causing business decisions to be made against the weight of evidence

For a copy of our Fraud Bribery and Corruption policy please click here.

 

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