Fraud in the NHS Iain Flinn Counter Fraud Specialist March 2011 - PowerPoint PPT Presentation

Fraud in the NHS Iain Flinn Counter Fraud Specialist March 2011

Areas Susceptible to Fraud  Procurement  Qualifications  Sickness / Attendance / Time Recording  Ghosts  Salary payments  Prescriptions  Health Tourists

National / Local Strategies  Counter Fraud Service  Counter Fraud Specialists  Trust Policies  Pro active exercises

Scale of the problem  3605 New investigations in 09-10  £3.4 million value  £167k criminal compensation  £2.04million civil recovery, voluntary repayment

Examples  London Hospital manager - £200k fraud  Ran private business using NHS funds  Bypassing of ordering procedures • E.g. £4000 CCTV system • £8000 invoice for “NHS equipment”  33 month custodial sentence, confiscation proceedings

Ghost Care Home  Senior manager - £117k fraud  Invented care home and used real patient ID numbers  No procurement involvement  Segregation of duties  Authorisation of invoices  4 year custodial sentence  Partner sentenced to 3 years for money laundering

Hospital Engineer  £80k fraud through collusion with supplier  Bogus orders submitted for private use  Segregation of duties  Bypassing normal supplies ordering procedures  Inappropriate supplier for type of equipment  Asset register checks  30 month custodial sentence, £80k civil recovery

Things to Consider  What are the fraud risks for your area of work?  Are you working to Trust policy / best practice or shortcuts / workarounds?  If you suspect fraud… REPORT IT.

ANY QUESTIONS?