Counter Fraud - NHS Tees Valley CCG

Impact of Fraud on the NHS

It is estimated that the NHS loses £1.21 billion per year, or roughly £3.3 million per day, to fraud. This is taxpayers’ money that is taken away from patient care and falls into the hands of criminals. This is enough money to pay for over 40,000 staff nurses, or to purchase over 5,000 emergency ambulances. When we say ‘fraud’, we refer to a range of economic crimes, such as fraud, bribery and corruption or any other illegal acts committed by an individual or group of individuals to obtain a financial or professional gain.

How does the CCG fight fraud?

AuditOne, the CCG’s counter fraud provider works closely with the CCG to combat fraud. We have a team of experienced counter fraud specialists delivering a full range of counter fraud, bribery and corruption services including prevention, detection and investigation. Our professionally qualified counter fraud specialists work to identify potential fraud, bribery and corruption risks through policy and system reviews and suggest remedial action to reduce and mitigate these risks. We are experienced in carrying out timely criminal investigations, from referral to prosecution.

AuditOne is an NHS consortium providing counter fraud services to 23 NHS and independent health care provider organisations across the North of England. It is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and is a not-for-profit organisation.

Who is the CCG’s counter fraud specialist?

A photograph of Paul Bevan, Counter Fraud Specialist — **Paul Bevan**
Counter Fraud Specialist

How we help tackle fraud

The CCG has a number of processes that support its Standards of Business Conduct and Declaration of Interest arrangements. This focusses on staff and organisational behaviour. By following the Policy and processes, staff working in or associated with the CCG can help prevent fraud. This covers the following areas:

Standards of business conduct
Gifts and hospitality
Declarations of interest

The Policy can be found here .

Additional information and the Registers can be found here.

Preventing fraud

The NHS Counter Fraud Authority have produced some useful reference and prevention guidance documents for NHS organisations. There are several fraud reference guides available which cover the following areas:

NHS staff – This relates to a person working in, or for, the NHS in any capacity. This includes salaried employees, retired employees receiving an NHS pension, agency staff, trainees, contractors such as GPs, dentists, pharmacists, opticians and their organisations and any other contractors who work for the NHS in the same manner as an employee.
NHS patients – This relates to a patient, that is someone obtaining treatment, services or medication from the NHS. It may relate to someone using the NHS (either in the UK or abroad) to obtain medical, dental, optical or pharmacy services.
NHS suppliers – This relates to a person or organisation providing goods and/or services to the NHS. This can include contractors (individuals or companies), suppliers, or other organisations.
NHS systems – This relates to fraud in relation to financial accounting, performance, incentives or penalties or any other financial issue.
Third parties – This relates to a person or organisation not linked to the NHS but trying to gain financially from it. This would include a third party making unsolicited requests for payment from the NHS or someone using an NHS facility to which they are not entitled.

There are also eight quick guides which covering different types of procurement frauds to aid prevention of these types of fraud:

Credit card fraud quick guide

How to report fraud

If you suspect fraud is occurring, you can help by reporting your suspicions confidentially to the counter fraud specialist.

Follow these simple guidelines when reporting your suspicions:

Do make an immediate note of your concerns
Do deal with the matter promptly if you feel your concerns are warranted
Don’t do nothing
Don’t be afraid to raise your concerns
Don’t approach or accuse individuals yourself

Don’t try to investigate the matter yourself

How to contact a Counter Fraud Specialist

The CCG’s counter fraud specialist can be contacted via the following:

Fraud Hotline: 0191 441 5936

Email: counterfraud@audit-one.co.uk

You can also report suspicions of fraud to the CCG Chief Finance Officer

Contact the National Fraud and Corruption reporting line

Alternatively, you can phone the National Fraud and Corruption reporting line: 0800 028 40 60

All calls are made in strictest confidence and no attempt will be made to persuade you to provide your personal details if you want to remain anonymous. You will be given a call reference number which you can quote if you phone again with additional information.

Finally, you can report allegations of fraud online directly to the NHS Counter Fraud Authority at https://cfa.nhs.uk/reportfraud

Fraud Champion

Each NHS organisation is required to nominate a fraud champion whose role is to support the counter fraud specialist in promoting awareness of fraud across the CCG. The CCG’s fraud champion is Lynne Walton, Deputy Chief Finance Officer. Staff should be aware that fraud champions are not authorised to investigate allegations of fraud. Therefore, staff should not report suspicions to fraud champions.