NHS Counter Fraud Service FAQs
Q: What is the NHS Counter Fraud Service?
A: The NHS Counter Fraud Service is part of the NHS Counter Fraud and Security Management Service. It has responsibility for preventing, detecting and investigating fraud against the NHS.
Q: What does counter fraud work entail?
A: Counter fraud work ranges from issuing penalty notices as a result of patients falsely claiming exemption from prescription charges to the multi-million-pound claims against drug companies for alleged price-fixing. Overall, it means:
- preventing, where possible, the illegal obtaining of money, services or resources from the NHS by deception
- detecting and taking action where prevention is not possible.
The NHS Counter Fraud Service has developed clear goals and a business process for tackling fraud.
Q: Who commits NHS fraud?
A: Types of fraud and offenders vary. For example:
- Patients may avoid paying prescription charges by falsely claiming exemptions or use aliases to obtain controlled drugs.
- Professionals may alter prescriptions, claim for work not undertaken or create ‘ghost patients’.
- Managers and staff may gain employment with false documentation or submit false claims – for example, timesheet and payroll fraud, claims for non-existent employees and for equipment never purchased.
- Contractors and suppliers may exaggerate or falsify records of NHS work.
Q: What are the most common types of NHS fraud?
A: There is an enormous variation in the types of fraud that are committed. Among the more recurrent kinds of fraud are staff and professionals claiming money for shifts not worked (commonly known as ‘timesheet fraud’), patients falsely claiming exemption from optical, dental or pharmaceutical charges (‘patient fraud’) and staff working in unauthorised jobs while on sick leave.
Q: How much of a problem is NHS fraud?
A: Fraud in the NHS is a drain on the valuable assets meant for patient care and costs the health service hundreds of millions of pounds. The situation is improving year on year as recovery of money, prosecution of offenders and awareness of the issue continue to build. However, there is still a considerable amount of money lost to patient, practitioner and staff fraud. The NHS Counter Fraud Service aims to reduce NHS fraud to an absolute minimum, and maintain it at that level.
Q: What work is being done to stop fraud happening in the first place?
A: The NHS Counter Fraud Service is committed to learning from its experiences in combating fraud. Successful detection of fraud gives health bodies an opportunity to revisit their systems and see where they can be further tightened. Moreover, Local Counter Fraud Specialists based in health bodies are authorised to undertake proactive exercises if there is evidence that a certain area of the health body’s work may be at risk of fraud. The NHS Counter Fraud Service itself undertakes regular national proactive exercises to identify areas where fraud could take place. It then develops measures to ensure that fraud is made as difficult as possible to commit and easier to detect and prosecute.
Q: How successful is counter fraud work?
A: The NHS Counter Fraud Service has a 96% success rate for prosecutions – higher than any other law enforcement agency when it comes to prosecuting fraud.
Q: How much does counter fraud work benefit the NHS?
A: Counter fraud work returns money and other resources to patient care. It also prevents future losses by deterring people from attempting fraud and, where this is not possible, by implementing measures to prevent the fraud that is attempted. Finally, it creates an awareness of what constitutes fraud, how the NHS suffers and what action can be taken. This encourages honest staff and patients to be vigilant and help increase the success of fraud prevention.
Q: How much support is there for counter fraud work?
A: The NHS Counter Fraud Service has signed agreements and charters with a range of professional organisations and regulatory bodies that support its counter fraud work. It has also signed memorandums of understanding with key law enforcement agencies. These include HM Revenue & Customs, the Association of Chief Police Officers and the Audit Commission.