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Investigating NHS Crime

The opportunity arose for me to work as a Local Counter Fraud Specialist (LCFS) in the NHS 10 years ago after working for a Local Authority investigating Benefit Fraud offences. The architecture of the NHS is very different to that of a Local Authority and I can remember quite distinctly how confused I was initially at trying to understand the differences between a Primary Care Trust (as it was then), a Mental Health Trust and a Hospital Trust. Although confusing to start with, I have found that the NHS is a fascinating place to be employed.

Already an Accredited Counter Fraud Specialist, I was able to commence investigating allegations of fraud, bribery and corruption straight away, following a one day NHS conversion course in Coventry. Initially, I was placed within the Primary Care setting where the types of fraud I investigated included:

  • Patient Prescription fraud
  • Dental Fraud – e.g. claiming for ghost patients
  • Ophthalmic fraud
  • General Practice fraud
  • Pharmaceutical fraud
  • Staff fraud (also known as insider fraud)

Since those days the architecture of the NHS changed radically and the Clinical Commissioning Groups were borne out of the Primary Care Trusts and with it the loss of investigating Primary Care offences.

I was next placed at Hospital Trusts and I am currently nominated as LCFS for the majority of Audit Yorkshire Hospital Trust clients. It can be seen that similar types of fraud occur at Hospital Trusts and therefore having this knowledge we can ensure that preventative measures are put in place in order to prevent similar offences occurring at neighbouring Trusts. A large part of LCFS time is used in raising awareness of fraud within the Trusts. Often staff are unaware that fraud exists within the NHS and it is the role of the LCFS to ensure that all staff know what fraud is, how to spot it and how to refer it. Due to the transient nature of the NHS, this element of the role is never ending. Essentially, it is more cost effective to prevent fraud from being committed than to investigate it and so we aim to ensure robust systems block any opportunities for would-be fraudsters. We can see the modus operandi of fraudsters ever changing and it is imperative that LCFSs keep up to speed with new and emerging frauds. The types of fraud I investigate now include;

  • Payroll fraud
  • Invoice fraud
  • Working elsewhere whilst claiming sick pay from the Trust

All anti-crime staff at Audit Yorkshire attend Fraud Forums where speakers are invited to attend to discuss relevant fraud issues. The forums are a good opportunity to learn about specific topics and also to meet other LCFS who work within the NHS up and down the UK.

The work of an LCFS is extremely varied and a new referral can arrive at any time and this might affect any plans already made for the day. One day is never the same as the next and this makes for an interesting working life. It is extremely satisfying to see a case finish in the courtroom knowing that the recovery of monies lost can commence and resources are returned back to where they were taken from.