COUNTERING FRAUD AND BRIBERY Camden CCG Patient and Public Engagement Meeting Gemma Higginson, 6 June 2016
What is fraud? • For an offence to have occurred, the person must have acted dishonestly with the intent of making a gain for themselves or anyone else, or inflicting a loss (or a risk of loss) on another. • Person must have acted dishonestly
Fraud Act 2006 • Three main offences • All require the element of dishonesty to be Abuse of Failure to False established. position Disclose representation Offences under the Fraud Act 2006.
The Bribery Act 2010 The offences • This first general offence is referred to as Give a active bribery and this constitutes the bribe offering, promising or giving of a bribe • The second general offence is referred to as passive bribery and constitutes Negligently Bribery fail to Receive a requesting, agreeing to receive or the prevent a Act bribe bribe accepting of a bribe • There is also a specific offence of bribing a foreign public official Bribe a foreign public official
Penalties: individual and corporate • Maximum of 10 years imprisonment • Unlimited fine • Potential risk of disbarment from EU tendering • Directors struck off • Massive reputational damage
Role of the Local Counter Fraud Specialist Inform and Involve Strategic Governance Hold To Account Prevent and Deter .
Examples of NHS fraud cases Prescription fraud • A CCG undertook a fraud investigation into a long standing and trusted member of the reception team at a GP Practice, who abused her position by taking advantage of poor IT policy procedures and adherence to those procedures. • Raised false prescriptions on elderly patients’ records who were in receipt of repeat prescriptions. • Supplied the fraudulent prescriptions to unknown 3 rd parties who then presented them at out of area pharmacies. • Sentenced to 12 months Conditional Discharge and ordered to pay costs and compensation.
Examples of NHS fraud cases Doctor – falsifying records • A doctor who stole over £62,000 from the NHS was sentenced to 9 months’ imprisonment (suspended for 18 months) and must pay £50,000 costs. • He admitted to falsifying the records of 1,703 patients to hit targets and increase payments from the NHS to his practice and pleaded guilty to two offences under the Fraud Act. • In just three days he manipulated the practice’s patient records system over 7,000 times in order to hit financial targets. He falsely claimed for patient checks he had not carried out.
What can You do? DO DO NOT Tell someone x Confront the individual Be aware of fraud issues x Try to investigate the matter yourself Make a note of your concerns x Delay Keep a record or copy any x Contact the police directly documentation that arouses your x Convey your suspicions to anyone other suspicion than those with proper authority to investigate x Do nothing
Reporting Concerns Counter Fraud Team Gemma Higginson Kirsten Quinn Chaya-orna Diamond : 07800 718 680 : 07436 268 340 : 07528 970 114 : gemma.higginson@rsmuk.com kirsten.quinn@rsmuk.com : chaya-orna.diamond@rsmuk.com • Chief Finance Officer: Ian Boyle • National Fraud Reporting Line : 0800 028 40 60 • Online reporting form at: www.reportnhsfraud.nhs.uk • Public Concern at Work: 0207 404 6609
Thank you for your time and attention
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