Fraud in the NHS

Fraud in the NHS is thought to cost on average around £5.7 billion every year and takes away money which services should be spending on patient care, funding towards further medical professionals or treatments. The total loss of procurement expenditure is estimated to be £1.05 billion, while the total loss to payroll fraud is estimated to be £0.56 billion.

What is fraud?

Fraud is defined as any dishonest false representation, failure to disclose information or abuse of position (Fraud Act 2006).

Bribery/corruption

Bribery and corruption are where someone is influenced by bribery, payment or benefit-in-kind to unreasonably use their position to give some advantage to another.' (Bribery Act 2010)

Who commits fraud?

Anyone can commit fraud against the NHS. People investigated include doctors, nurses, administration staff, managers, health care professionals, dentists, opticians, pharmacists, patients, directors, GPs and overseas patients.

Examples of fraud (list not exhaustive)

The types of fraud investigated in the NHS include the following:

  • false time recording (overtime, flexi time, enhanced hours etc)
  • false qualifications/professional registrations
  • working while sick
  • claiming additional or fictitious expenses
  • false charge exemptions
  • ordering/invoices
  • mandate fraud
  • contractor claims
  • employees not having the correct or legitimate right to work documents
  • employees having expired right to work documents
  • procuring of goods and services in an non-transparent and dishonest manner
  • commissioners claiming for services in respect of factious or ghost patients
  • false identity

What to do if you suspect a fraud?

  • DO report your suspicions confidentially to someone with the appropriate authority and experience.
  • DO deal with the matter promptly if you feel your concerns are warranted.
  • DO NOT ignore it.
  • DO NOT approach or accuse individuals directly.
  • DO NOT try to investigate the matter yourself. DO NOT convey your suspicions to anyone other than those with the proper authority.

Who to contact

The trust adopts a zero tolerance approach towards fraud being perpetrated. Therefore, if you have any concerns about fraud, bribery or corruption within the NHS, or need fraud related advice, you can contact the NHS Fraud and Corruption Reporting Line on 0800 028 40 60 (this is a free phone service and lines are open Monday to Friday from 8am-6pm), via the online reporting form www.reportnhsfraud.nhs.uk at NHS Protect, or via your Local Counter Fraud Specialist Stevan Burtenshaw on 07528 970136 or s.burtenshaw@nhs.net. All referrals/discussions will be dealt with sensitively and in a professional and confidential manner.