Counter Fraud

Man on telephone in office

Fraud against the NHS is a drain on the valuable assets meant for patient care and costs the health service billions of pounds every year.

Types of fraud and offenders can include:

  • Patients falsely claiming travel expenses;
  • Staff may gain employment with false documentation;
  • Staff may claim pay for shifts they did not work;
  • Contractors may exaggerate or falsify records of NHS work.

It is clear that fraud prevents health services from being run in the best possible way and impacts on staff and resources.

Each health body has its own Local Counter Fraud Specialist (LCFS) who is responsible for overseeing its fraud-proofing measures, studying the financial comings and goings, looking for anything suspicious, raising awareness of the issues and investigating suspicions of fraud.

This Trust is required by law to protect the public funds it administers. It may share information provided to it with other bodies responsible for auditing and administering public funds, in order to prevent and detect fraud. It is also responsible for carrying out data matching exercises.

Data matching involves comparing computer records held by one body against other computer records held by the same or another body to see how far they match. This is usually personal information. Computerised data matching allows potentially fraudulent claims and payments to be identified. Where a match is found it indicates that there is an inconsistency that requires further investigation.

No assumption can be made as to whether there is fraud, error or other explanation until an investigation is carried out.

The Audit Commission currently requires us to participate in a data matching exercise to assist in the prevention and detection of fraud. We are required to provide particular sets of data to the Audit Commission for matching for each exercise, and these are set out in the Audit Commission’s guidance, which can be found at www.audit-commission.gov.uk/nfi.

The use of data by the Audit Commission in a data matching exercise is carried out with statutory authority under its powers in Part 2A of the Audit Commission Act 1998. It does not require the consent of the individuals concerned under the Data Protection Act 1998. Data matching by the Audit Commission is subject to a Code of Practice. This may be found at www.audit-commission.gov.uk/nfi/codeofdmp.asp.

For further information on the Audit Commission’s legal powers and the reasons why it matches particular information, see: www.auditcommission.gov.uk/nfi/fptext.asp.

For further information on counter fraud activity at the Trust please contact Alexandra Barrington (alexandra.barrington1@nhs.net).