Nick Dann Regional Manager NHS Counter Fraud Operational Service

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Nick DannRegional ManagerNHS Counter Fraud
Operational Service

• Countering Fraud In The Public Sector

CIPFA in the Midlands 28 November 2000
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BACKGROUND

• The NHS is the largest organisation in Europe
• It has more than one million employees
• It has a budget of more than 44 billion
• It has 99 Health Authorities and more than
  365 NHS Trusts
• 50 million customers

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Directorate of Counter Fraud Services

• Overall responsibility for all work to
  counter fraud and corruption within the NHS
• Direct responsibility for Strategy, Policy
  and Operations
• A specialist Directorate
• Counter Fraud Specialists in every Health
  Authority and NHS Trust

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The Story So Far
September 1998 Director appointed
(subsequently followed by 40 staff who
make up DCFS)

• September 1999 Regional Managers appointed
• October 1999 Counter Fraud Specialists
  appointed
• December 1999 All staff accredited Counter
  Fraud Specialist

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The Structure
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FRAUD - THE PROBLEM

• Social Security 3 - 4 billion
• Local Govt (HB only) 805 million
• MoD 180 million
• Customs and Excise 885 million
• Inland Revenue 821 million
• Banks and Insurance 960 million
• Credit Cards 189 million

• NHS

1 - 2 billion?
One problem is that we dont know enough about
the problem.
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The Cost

• Social Security- Spend 500 million
• 5000 Staff
• Loss 3 bn
• 16.66

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The Cost - NHS

• NHS - Loss 2bn (estimated)
• - Spend 4.2 million
• - 100 staff
• Operations and Training 3.2 million
• Directorate 1 million

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THE CHALLENGES

• 1.
• To minimise losses to the public purse.
• 2.
• To free up resources for better systems and
  better services.
• 3.
• To win and retain the publics trust and support.

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DCFS are committed to

• Reduce by 50 the evasion of prescription charges
  by end 2002/3
• To prevent 9 million of prescription fraud
  perpetrated by NHS contractors and recover a
  further 6 million by end 2001/2

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PROFESSIONALISM

• It means
• Having a clear REMIT
• Having the AUTHORITY to fulfil it
• Developing a clear STRATEGY and BUSINESS
  PROCESS
• (Measuring the PROBLEM accurately)
• (Creating an effective STRUCTURE)
• (Taking ACTION in all key areas)

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STRATEGY

• Key features - Comprehensive, Integrated,
  Professional
• Aims - Reduce fraud to an absolute minimum,
  hold it at that absolute minimum, free up
  resources for better patient care through
• Objectives - Changing the Culture,
  Deterrence, Prevention, Detection,
  Investigation, Sanction and Redress

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IN THE NHS .

• Risk Measurement Team fully set up
• Methodology published in December 1999 - NAO
  satisfied
• The first two exercises (on Patient
  Prescription Charge Evasion) published in
  December 1999 and 41 (48 million) reduction
  in losses identified (Accurate to /- 0.6)
• First annual program of exercises across the
  NHS to be completed by Spring 2001

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Quality Inspections

• Monitor standard of Counter Fraud work in health
  bodies
• Ensure appropriate sanctions and redress applied
• Ensure compliance with Secretary of States
  directions

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Counter Fraud Operational Service

• Operational arm of DCFS

Eight Regional Teams
One National Team
Two Specialist Teams
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Investigation Levels
Health Authority and NHS Trust Staff Up to 15k
CFOS Regional Teams 15 - 75k
National Team 75k plus
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Secretary of States Directions

• Issued December 1999 to all health bodies
• Requires appointment of accredited counter
  fraud specialist
• Requires reporting of all fraud
• Restricts direct referrals to police

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Current Investigations

• 332 Cases nationally
• Value 22.2 million
• 4.2 million offered for recovery
• 491 Subjects under investigation

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Training

• All persons responsible for the investigation of
  fraud will need to be accredited Counter Fraud
  Specialist
• Secretary of States Directions
• December 1999

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Training

• Free to every HA and NHS Trust
• Most HAs accredited by April 2000
• Trusts commenced May 2000

• BASIC LEVEL
• Investigation, law and procedures
• Investigative interviewing
• Proactive investigations
• Principals of Good Practice

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Thank You