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Fighting NHS fraud in Leeds
FROM invented overtime to doctored cheques, it all adds up to fraud.
When funds are stolen from the NHS, it means less money to treat sick people.
The health service may not seem like an obvious victim of fraud but because of its size, the opportunities are vast.
It could involve staff, patients or outside companies in huge variety of ways.
Amounts of money involved can also be massive – during the year 2007-2008, investigations by the NHS Counter Fraud Service saved 7.5m nationally. Since it was set up in 1999, the service has recovered more than 57m.
Across the country there are more than 300 Local Counter Fraud Specialists who work in NHS organisations to prevent fraud, investigate allegations and prepare cases.
Though their number is relatively small, their remit – and their importance – is massive.
As the largest hospitals trust in the UK, Leeds Teaching Hospitals has an annual budget of nearly 900m and more than 14,000 staff.
Ensuring that money is used for looking after patients and running the hospitals is the responsibility of local counter fraud manager David Gregory and his team.
Together with local counter fraud specialists Richard Schmidt and Lina Anderson, they work to combat all forms of fraud involving the hospitals trust.
The team's most common cases involve sick notes, such as them being forged, altered or employees working elsewhere whilst off sick.
Timesheet fraud, or claiming for overtime not worked, as well as fraudulent expenses claims are also frequently seen.
The team's role is to investigate activities like these – but also to prevent people from having the desire or the chance to commit fraud in the first place.
"We are trying to create an anti-fraud culture, promote the work we are doing and deter people from fraud," Mr Schmidt said.
"What we are trying to do is deter people, say 'think again, there's somebody watching you'.
"We want to reduce the risk of fraud in systems. If the right controls are in place, people should not be able to do it."
That means their prevention work is just as important as investigating cases of suspected fraud.
June is national NHS Fraud Awareness Month which aims to show the effects of fraud and how it can be stopped.
In order to developing better systems to prevent fraud, they will review the ways of running wards or departments.
"We identify one or two areas each year where we look at their policies and procedures and see how these work," Mr Schmidt said.
Because of their potential for misuse, one of the things they've cracked down on is sick notes.
They discovered an employee who had taken a block of sick notes and was issuing them to herself. She accepted a police caution.
The team looked at the controls on pads of sick notes as they come into the trust and also how they are distributed in order to take away the opportunity for potential fraudsters.
Another of their current projects is being involved with a national data matching exercise looking at information held by different Government bodies against that in NHS databases.
The exercise is run every two years and last time, in 2006/7, it identified fraud and overpayments of 140m.
Where matches are found, such as two people with the same National Insurance numbers, that information is passed on to the NHS trusts to see whether they require further investigation.
It might show someone working for two organisations at once – something which could be perfectly legitimate.
But, as Mr Schmidt explained, that could also indicate fraud.
“Somebody could be off sick for one organisation and going to work for another,” he said.
The team’s work has also prevented 26,000-worth of fraudulent invoices being paid by Leeds hospitals trust.
They were one of the many health bodies targeted in a nationwide employment vacancy advertising scam, where a real advert was copied and then sent to the trust as though they had asked for it to appear in a different publication.
If an unwitting staff member signed a fax relating to this, the trusts received an invoice for the ‘advertising’.
Three companies involved in advertising medical vacancies in this way have now been wound up in the High Court.
As well as this proactive work, the team also investigate reports of potential fraud.
They receive telephone calls and emails from within the Trust and outside, as well as referrals from the national NHS Fraud reporting line.
For each piece of information, they need to check if it is accurate, corroborate it, then decide whether it warrants further investigation.
In the past three years up to March 2009, the Leeds hospitals team investigated 97 reports of potential fraud.
Some were inaccurate and some showed activities which weren’t criminal, so these were dealt with by the hospitals trust’s internal discipline procedures.
Eight cases resulted in disciplinary sanctions.
If the case is potentially criminal, Mr Schmidt or Ms Anderson takes witness statements and interviews the suspect.
They don’t have the power of arrest or the ability to search property, so if these are needed they’ll bring in West Yorkshire Police to make arrests or conduct searches for evidence.
Prosecution
The counter-fraud specialists can carry out interviews under caution in the same way as the police and will put together a prosecution file as officers would.
That file is then passed to the Department for Work and Pensions, which prosecutes NHS fraud cases rather than the Crown Prosecution Service.
If the case goes to court, the prosecution file will be used to help bring the case.
Where money has been taken, the team look to recover that money and it is then returned to the department it was taken from.
Since April 2006 there have been nine criminal cases and in total 17,256 has been recovered and returned back to the departments that suffered the loss.
As well as the criminal investigations, internal inquiries and those by external bodies – like the General Medical Council – run alongside.
Though juggling prevention, proactive and reactive work can be tricky, the team get a huge sense of satisfaction when defrauded money is returned to the hospitals trust.
With the help of the honest workers and users of the NHS, they can help ensure taxpayers money goes towards healthcare and not into the pockets of fraudsters.
“By knowing how to recognise and report any fraud that does occur, we can help to ensure that the public funds of the NHS are spent on patient care,” Mr Schmidt said.
l The national NHS Fraud and Corruption Reporting Line is on 0800 028 40 60 or email nhsfraud@cfsms.nhs.uk. Callers can remain anonymous.
katie.baldwin@ypn.co.uk
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