EAST MIDLANDS

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EAST MIDLANDS Local Counter Fraud Services
PUTTING A STOP TO FRAUD CORRUPTION IN THE NHS

Presentation to NHS Derby City Board
Meeting 4th December 2008 PENNY GEE LOCAL
COUNTER FRAUD SPECIALIST
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EAST MIDLANDS Local Counter Fraud Services
THE NHS COUNTER FRAUD STRATEGY

• NHS Counter Fraud Service created in 1998 to-
• Tackle all losses to fraud and corruption in
  every area of NHS spending
• Address the problem of the minority who try to
  defraud the NHS of its valuable resources
• Aim
• To reduce fraud within the NHS to an absolute
  minimum and hold it permanently at that level to
  free up resources for better patient care.

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EAST MIDLANDS Local Counter Fraud Services
THE ROLE OF THE LCFS 7 GENERIC AREAS

• CREATING AN ANTI-FRAUD CULTURE
• e.g. Spreading the word about fraud, i.e.
  presentations, newsletters
• DETERRENCE
• e.g. Publicising successful cases in the press
• PREVENTION
• e.g. Input into policies procedures to stop
  fraud before it happens
• DETECTION
• e.g. carrying out exercises to detect fraud in
  identified areas
• INVESTIGATION
• All referrals are professionally investigated by
  trained staff
• SANCTIONS
• Criminal, disciplinary civil
• REDRESS
• e.g. recovering financial losses from fraudsters

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EAST MIDLANDS Local Counter Fraud Services
EXAMPLES OF FRAUD

• Submission of false timesheets
• False sickness claims
• False qualifications/references supplied/non
  declaration of convictions
• False/excessive expense claims submitted
• Incorrect use of donations
• Invoices submitted for goods not supplied
• Inappropriate use of communications equipment,
  telephone, email, internet, fax machines
• Abuse of official time, e.g. consultants treating
  private patients in NHS time
• Receipt of gifts for inducement or reward
• Patients falsely claiming exemptions/entitlement
  to NHS services
• Practitioners claiming for treatments/services
  not supplied

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EAST MIDLANDS Local Counter Fraud Services
PARALLEL SANCTIONS

• CRIMINAL Prosecution through the courts,
  resulting in criminal records if found guilty
• DISCIPLINARY INTERNAL, i.e. warnings,
  suspension, dismissal / EXTERNAL, informing
  professional bodies of outcomes, i.e. NMC, GMC
• CIVIL Recovery of funds, Trusts will pursue
  fraudsters by means of civil action in order to
  retrieve the money defrauded, compensation and
  investigation costs

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EAST MIDLANDS Local Counter Fraud Services
What have we done within the PCT?

• Anti-Fraud Policy produced
• Presentations delivered to staff groups GP
  Practice staff
• Production of Fraudulent Times newsletter
  (counter fraud page to be created on intranet
  site)
• Protocol agreed with Communications re
  publicising successful cases
• Circulation of warnings/scams reporting into
  National Intelligence Unit
• Working with Risk Management to identify risk
  areas feed into the risk register
• Review of policies/systems/procedures to prevent
  weaknesses that allow fraud reporting these to
  CFSMS Policy Unit
• Identifying weaknesses making recommendations
  following investigations
• Participation in data matching exercises
• Protocol agreed with HR to maximise available
  sanctions

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Referrals Received
EAST MIDLANDS Local Counter Fraud Services
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Referrals by Type
EAST MIDLANDS Local Counter Fraud Services
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Referrals by Source
EAST MIDLANDS Local Counter Fraud Services
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Referrals by Outcome
EAST MIDLANDS Local Counter Fraud Services
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CASE STUDIESNottingham Practice Manager
Sentenced
EAST MIDLANDS Local Counter Fraud Services

• In September 2008 a former practice manager from
  Nottingham was given a 51-week suspended
  sentence, a 12-month supervision order and a
  six-month curfew at Derby Crown Court after
  charging personal goods to the NHS, and
  falsifying overtime and petty cash claims valued
  at up to 28,000.
• She had been employed by Derbyshire County PCT
  as practice manager at Charlton House Medical
  Practice for two years but resigned in November
  2007 amidst an investigation by the NHS Local
  Counter Fraud Specialist (LCFS) and the
  Derbyshire Police.

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CASE STUDIES Temporary Admin Worker
Sentenced for Falsifying Timesheets
EAST MIDLANDS Local Counter Fraud Services

• A Temp Admin worker was sentenced in March 2008
  for falsifying timesheets submitted to Derbyshire
  Mental Health Service NHS Trust. She claimed for
  more hours than she had actually worked resulting
  in a net loss to the trust of 1671.
• Her contract with the Trust was terminated on
  discovery of the fraud. She was ordered to repay
  the 1671 to the Trust via the Court and ordered
  to pay 500 prosecution costs . The Court imposed
  a Community Punishment Order for 180 hours unpaid
  work.

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EAST MIDLANDS Local Counter Fraud Services
CASE STUDIES Derbyshire Healthcare Assistant
Jailed for Timesheet Fraud

A Healthcare Assistant was jailed for 15 months
in December 2005 for cheating the NHS out of
50k. Between June 2002 and October 2004 he had
submitted timesheets to the ETI nursing agency
for work he never undertook. The fraud was
discovered when staff at the Trust noticed his
name on an invoice and were surprised,
considering he had not worked there for 2 years!
The suspicions were referred to the East Midlands
Regional Team of the NHS Counter Fraud Service.
Hospital duty rosters and interviews with staff
confirmed that he had not worked any of the
shifts he claimed for. Including agency fees, the
total loss to the Trust ran to 80k.
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CASE STUDIES Nottingham Pay Officer Sentenced
EAST MIDLANDS Local Counter Fraud Services

• A Pay Officer from Nottingham was sentenced to
  two years Conditional Discharge and ordered to
  pay 250 in costs at Nottingham Crown Court after
  attempting to defraud the NHS of more than 3000.
  
• The employee, who resigned from Sherwood
  Forest Hospitals NHS Trust, was charged with two
  counts of False Accounting after admitting she
  transferred 3332 that she was not entitled to
  from the Trusts payroll system into her bank
  account in 2006.
• The LCFS found that the employee had transferred
  the money to herself and then changed the bank
  details in order to cover up the transactions.
  Further checks with her bank confirmed that the
  payments had been received and that they had
  since been used.

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EAST MIDLANDS Local Counter Fraud Services
PROGRESS NATIONALLY 1999 - 2007

• 482 successful prosecutions
• Over 500 successful civil, legal and disciplinary
  cases
• 95 successful prosecution rate
• Overall losses from patient fraud have been cut
  by 55
• 822m financial benefit to the NHS

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EAST MIDLANDS Local Counter Fraud Services
PROGRESS NATIONALLY 1999 - 2007

• 57.5m recovered
• Over 300 trained and accredited counter fraud
  specialists
• In some areas, claims by NHS professionals have
  fallen by 61 after fraud was proven in processes
  involved

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EAST MIDLANDS Local Counter Fraud Services
CONTACTS/FURTHER INFORMATION
Penny Gee Principal Local Counter Fraud
Specialist Tel [phone] Email
penny.gee_at_derwentsharedservices.nhs.uk Gary
Roe/Ruth Leachman-Koko LCFS (Support) Tel
01332 868898 Email gary.roe_at_derwentsharedservices
.nhs.uk ruth.leachman-koko_at_derwentsharedservices.n
hs.uk NHS Fraud Corruption Reporting Line
Tel [phone] NHS CFSMS Regional Office
Tel [phone] CFSMS Website
www.cfsms.nhs.uk (follow link to recent cases)

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EAST MIDLANDS Local Counter Fraud Services
Thank you for listening ANY QUESTIONS?