Reporting NHS fraud

Fraud against the NHS means that the money intended for patient care, and funded by the taxpayer, ends up in the pockets of those who did not legitimately earn it. It means fewer resources are available to be spent on frontline health services such as patient care, health care facilities, doctors, nurses and other staff.

Fraud, bribery, corruption and other illegal acts committed to obtain financial or professional gain, cost the NHS billions of pounds every year. In 2019/20 it was estimated that the cost to the NHS was around £1.14 billion per annum, as per the NHS Counter Fraud Authority, who assess that to be enough money to pay for over 40,000 staff nurses or to purchase over 5,000 frontline ambulances.

North Central London Clinical Commissioning Group is committed to maintaining an honest, open and well-intentioned approach to best fulfil the objectives of the NHS. This means the CCG operate a zero-tolerance approach to fraud and bribery. Such conduct, at any level, is unacceptable. The CCG ensures that there are effective controls in place throughout the organisation, including stringent policies and internal systems to prevent and detect bribery, in accordance with the Bribery Act 2010, and to counter fraud by ensuring compliance with the NHS Counter Fraud Authority requirements to comply with the Government Functional Standard for Counter Fraud.

Fraud happens when someone makes a deliberate attempt to dishonestly make a gain for themselves or another, or cause a loss to another. This may include any person who makes a false representation or dishonestly fails to disclose to another person information which they are under a legal duty to disclose, or commits fraud by abuse of position, including any offence as defined in the Fraud Act 2006. Examples of the three main fraud offences are provided below. Further information can be found in our Anti-Fraud Policy.

False representation

This is the most common type of fraud investigated within the NHS. This normally involves a false declaration being made, such as claiming to be sick from an NHS role whilst working elsewhere. The staff member is being paid sick pay by the CCG, but is then being paid for secondary employment too, whether that is in the NHS or another employer.

Failure to disclose

This could be relating to any information where there is a legal duty to disclose. For example, failing to disclose a criminal record or anything that could affect your DBS checks.

Abuse of position

This is when someone is in a position where they are required to safeguard the financial interests of another, such as the CCG or a vulnerable person for whom they are power of attorney, and they abuse that position, for personal or financial gain, or to cause loss to another. Essentially, those who know how to use the systems, but ultimately abuse them too. For example, an individual in a management position who uses their knowledge and authority to divert approved payments into a bank account in their name.

Bribery refers to the giving or receiving of an inducement, in return for a person committing an improper function. It is an offence to give or receive a bribe, or even offer or accept, even if the briber is never paid. A bribe is any inducement, financial or not, to encourage or reward someone to do something they should not do. Bribery does not have to involve cash, and the corrupt person may not benefit directly from their deeds, however, they may be unreasonably using their position to give some advantage to another. The four main offences under the Bribery Act 2010 are detailed below. Further information can be found in our Anti-Bribery Policy.

  • Give a bribe
  • Negligently fail to prevent a bribe
  • Receive a bribe
  • Bribe a foreign public official

Some common forms of bribery include cash, facilitation, payments, gifts, hospitality, political donations, charitable contributions, enhanced commissions, and employment of friends or family.

The first steps are being aware of the risk and remaining vigilant. You should also know how to report any suspicions or concerns you may have about fraud and/or bribery.

North Central London CCG contracts RSM to provide the CCG’s Counter Fraud service.

If you have any suspicions or concerns please talk to the Local Counter Fraud Specialist (LCFS) team as soon as possible; they will be able to provide you with appropriate advice and guidance with any issues relating to fraud or bribery. It is important to remember that your concerns may be important to prevent on-going fraud being committed against the CCG and to prevent funds being diverted inappropriately.

The LCFS team can be contacted as follows:

  • Kirsty Clarke: 07436 268545 or at kirsty.clarke8@nhs.net /  kirsty.clarke@rsmuk.com
  • Amanda Kalawa-Conteh: 020 3201 8453 or at  amanda.kalawa-conteh@nhs.net / amanda.kalawa-conteh@rsmuk.com
  • Matt Wilson: 07484 040691 or at matt.wilson2@nhs.net / matt.wilson@rsmuk.com