Fighting the fraudsters

Each year the NHS loses millions of pounds as a result of fraudulent activity and the laboratory environment is not immune to this. But as Barry Hill discovered, one organisation is now determined to stamp this out.

IN 2005, a director of a medical equipment leasing company who devised a £4.5million scam to cheat NHS trusts into overpaying for contracts was jailed for 8 years. The case was detected by the NHS Counter Fraud Service (NHS CFS) who went on to ensure that the practice was immediately investigated. The scale of the fraud was then revealed following a series of interviews with 35 NHS trusts relating to 55 equipment leases. The fraud consisted of winning tenders to lease medical and laboratory equipment to health bodies by offering low rates, then passing a doctored version of the lease agreement to a professional finance house wherein the lease had been extended by two years to earn additional commission.

This investigation is just one example of the work of the NHS CFS, part of the NHS Counter Fraud and Security Management Service, which has responsibility for preventing, detecting and investigating fraud against the NHS, and ensuring the security of its staff and property. The NHS CFS was established in 1998, and quickly discovered that all parts of the NHS have been exposed to or are vulnerable to fraud. So successful has it been in preventing fraud since its inception that it has to date recovered some £51 million which has been re-invested into patient treatment and care, as well as preventing even more money being lost to the health service.

Fraud in the NHS comes in many different guises and can be committed by practically anyone. According to NHS CFS managing director Dermid McCausland, there is no single profile of an NHS fraudster. Previous examples of NHS fraud have been committed by patients, relatives of patients, laboratory workers, nurses, consultants, contractors and even NHS Trust chief executives. “There is an enormous variation in the types of fraud that are committed, as there are people who commit them and we take every case, no matter how big or small, very seriously. Allegations of fraud are always investigated thoroughly and professionally, and where fraud is proved, we always press for the toughest possible sanctions. Amongst the more recurrent kinds of fraud are theft, staff and professionals claiming money for shifts they have not worked (‘timesheet fraud’), fraudulent expenses claims, patients falsely claiming exemption for optical, dental or pharmaceutical charges (‘prescription fraud’) or staff working in unauthorised jobs while on sick leave. Our fraud work therefore encompasses preventing the illegal obtaining of money, services or resources from the NHS by deception and detecting and taking action where prevention is not possible”.

With over 18 years’ experience of countering fraud in a public sector environment, Dermid’s current focus has been to implement innovative communications strategies to develop an anti fraud culture in the NHS as well as evoking a strong deterrent effect. “I see my role as one of ensuring that we continue to deliver real financial benefits and savings to the NHS by ensuring monies lost to fraud are recovered and returned. Mechanisms have been introduced to assist this which utilise the goodwill of the honest majority who work in or use the NHS, to deter the dishonest minority from committing fraud”.

Although fraud detection is steadily improving, there is still a considerable amount of money being lost to the detriment of the NHS as Dermid outlines. “Fraud reduces the NHS of valuable resources intended for patient care and could even cost lives. Measuring fraud across an organisation the size of the NHS is an immense task, but we estimate that fraud committed by patients cost the NHS £171million in 1998, reduced to £76 million in 2006. Claims for dental domiciliary visits for example reduced from £14 million in 1998, to £5 million in 2006 after counter fraud measures were introduced”. Not only has the NHS CFS been an extremely cost effective measure to date, it also prevents future losses through deterring and preventing fraud from occurring.

Dermid believes that instilling an anti-fraud culture into the workplace has been integral to this “This creates an awareness of what constitutes fraud, how the NHS suffers and what action can be taken, therefore ensuring that honest staff and patients are themselves remain vigilant against fraudsters”. In terms of actual prosecutions, the NHS CFS has had impressive results. Over the last five years they have investigated over 1900 cases of suspected fraud resulting in 422 criminal prosecutions and 341 civil or disciplinary sanctions.

In his time at the NHS CFS however, Dermid has seen practically every type of fraud, but he is still surprised by what is uncovered. “In a recent case a laboratory worker who used his Trust’s mailing system to deliver a large number of items he had sold on the internet was sentenced to a conditional discharge, compensation and costs. The laboratory worker not only conducted auctions on the internet auction site eBay, but also sent items to buyers using the hospital’s postal system paid for by the trust. It was only when a buyer saw the NHS franked packaging and contacted the fraud reporting line that the fraud was investigated.

Further enquiries revealed that he had been using his NHS email address as a contact on eBay and had conducted over 900 transactions on the site, a large part of which were believed to have been whilst he was actually on duty at work. Some items sold were items of laboratory equipment believed to have been stolen from the department in which he worked. The technician pleaded guilty to 8 specimen counts of obtaining services by deception from the Trust and he was subsequently sentenced to 12 month conditional discharge and ordered to pay compensation and costs.

We also had a case involving a laboratory manager who over a five year period sold bones and tissue to private clinics, but instead of paying the money to the hospital, he redirected the money into his own bank account. The laboratory manager was sentenced for stealing an estimated £12,000 from the Northern General Hospital in Sheffield, part of the Sheffield Teaching Hospitals NHS Trust. The Bone Bank in question is provided by the Trust and based at the Northern General Hospital and holds stores of donated bone that are prepared and then provided for use in future surgery in the NHS and private hospitals. As well as receiving a 10 month custodial sentence, he was ordered to pay £4,500 in prosecution costs and £12,443 to the Trust in compensation.

In another case a pathology supervisor at Portsmouth Hospitals NHS Trust was found guilty of defrauding the NHS of £3,655. The pathology worker falsified records to show more overtime than she had actually worked between January 2006 and March 2007. She pleaded guilty to eleven charges of false accounting and was sentenced to 120 days custody plus 120 hours unpaid work in the community and was also ordered to pay £300 compensation. The pathology worker had worked at the trust since 2004, but in 2006 began altering the attendance records for the pathology support services department. She increased the amount of overtime pay she was owed after the record had been signed off. However, the manager of the department became suspicious when she saw how much overtime had been paid and then reported the matter to the local CFS. The pathology worker was also subsequently dismissed from her job’.

Ultimately Dermid and his colleagues aim is to reduce fraud to an absolute minimum, but to do this they need help. “Fraudsters are determined people and are constantly looking for new methods of cheating and defrauding the NHS. I believe NHS CFS must learn from every type of fraud and put effective measures in place to stop them happening again. Our aim is to raise awareness levels to fraud and to encourage healthcare staff and the public to report it where they see it and assure them it will be acted upon. Then we will be an organisation that is fully equipped to deal with each and every new fraud we encounter”.

Dermid believes therefore that as long as the fraudsters are out there then all health professionals can play an important part in helping to combat these crimes. “Laboratory Managers and laboratory staff can therefore act as our eyes and ears in alerting us to this. Should they have any suspicions of fraudulent practice or the mismanagement of NHS funds, it is essential they report it to their Local Counter Fraud Specialist or via the freephone NHS Counter Fraud and Corruption Reporting line at the earliest possible opportunity. Fraud against the NHS is not a victimless crime, it is the patients who are losing out”.

NHS Counter Fraud and Corruption Reporting line 0800 028 40 60

By Barry Hill. Barry has worked within pathology for over 30 years and specialises in the discipline of blood transfusion & haematology.