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Tackling NHS fraud
28/01/2008
A new strategy in the fight against fraud in NHSScotland was launched today.
While it is only a tiny minority of people who defraud the NHS, their actions cost the service. It is estimated, up to one per cent of the NHS budget could be lost annually. This means as much as £50 million - £100 million may be filtered out of the NHS by fraudsters each year.
Promising zero tolerance, Cabinet Secretary for Health and Wellbeing Nicola Sturgeon set out a range of new measures which will not only help identify and combat fraud by staff, clinicians, contractors and patients, but importantly act as deterrents.
NHSScotland Counter Fraud Services (CFS), set up to deter, detect and investigate cases of potential NHS fraud has estimated that £14 million in NHS fraud savings have been made since the agency was established in July 2000.
This is the equivalent of almost 750 extra nurses or 120 additional consultants. Alternatively, it could pay for more than 2000 hip replacements operations or 93000 MRI scans. Or, it could pay for nearly 163,000 attendances at Accident and Emergency.
Ms Sturgeon, who launched the strategy at the CFS's offices based in Livingston today, said:
"Let me make it clear that fraud in the NHS will not be tolerated in any form. While only a tiny minority of people defraud the NHS their actions cost the service dear. Whether committed by staff, patients, clinicians or contractors, NHS fraud takes money away from where it is needed most.
"We are therefore determined to ensure that the problem of fraud is tackled as effectively as possible.
"Protection against fraud must begin at the earliest stages when healthcare policies, systems and procedures are being designed, before they are finally agreed and rolled out.
"At the other end of the spectrum, we need to engage with those who work in, and use the services of, the NHS and ensure that they understand the damage caused by fraud and the need to protect our NHS.
"The Scottish Government is committed to sustaining and improving the health and wellbeing of the people of Scotland and we need to safeguard our NHS resources for this purpose.
"We will continue to work in partnership with NHS bodies in Scotland and other key partner organisations to deliver national and local counter fraud services.
"We welcome the signing of the Counter Fraud Charter and the Memorandum of Understanding by the Royal College of Nursing Scotland and the General Medical Council in a joint determination to tackle fraud and look forward to working with them and other organisations."
Neil Billing, Head of Service, NHSScotland Counter Fraud Services added:
"Fraud against the NHS impacts on all of us and we all have a responsibility to combat it.
"We welcome our new working relationship with the Royal College of Nursing Scotland and the General Medical Council which will make a significant contribution to implementing CFS actions in line as set out in the Scottish Government's new Counter Fraud Strategy."
The new NHS Counter Fraud Strategy has a strong focus on deterrence. NHSScotland Counter Fraud Services will develop a new e-learning package for use in the induction of NHS staff. It will also create a DVD to help NHS managers identify types of staff behaviour which may signal fraudulent activity.
For maximum deterrence, methods such as 'triple tracking', which reflect modern thinking in the counter fraud world will be employed, engaging criminal, disciplinary and civil action where appropriate.
Ms Sturgeon has also called for 'counter fraud champions' to be identified at senior level in health boards to raise awareness among staff of NHS fraud and their individual responsibilities for tackling it.
The Scottish Government has recently joined the European Healthcare Fraud and Corruption Network, which will facilitate the exchange of experiences, ideas and lessons across bodies in Europe who are tackling healthcare fraud.
Despite a minority of people committing fraud, it is estimated that up to one per cent of the NHS budget could be lost annually through fraud, meaning as much as £50 million - £100 million each year.
NHSScotland Counter Fraud Services, estimates that it has made almost £14million (net) in fraud savings for the NHS since it was established in July 2000 (this equates to £22 million gross).
NHSScotland Counter Fraud Services operates a free phone fraud hotline (08000 15 16 28) and website which may be used by anyone within or outwith the NHS, who wishes to report any incident of potential fraud in or against NHSScotland, anonymously if desired.
Types of Fraud
Patient - Primary and Secondary Care
a) Claiming to be exempt from NHS charges for dental treatment, optical vouchers and prescription charges.
b) Using false identities: falsifying prescriptions in an attempt to obtain more drugs and using false names and medical information.
c) Altering dates on pre-payment certificates.
d) Health tourism - using the NHS for operations and treatments free of charge.
NHS Staff
a) Claiming travel and subsistence expenses for journeys not taken or inflating mileage.
b) Falsifying overtime/ time payment sheets - claiming for hours not worked
c) Working whilst of sick - including Bank Agency nursing
d) Claiming payments for private work undertaken of NHS time and/ or NHS premises.
e) Staff clocking colleagues on shifts not worked
f) Misuse of fuel cards for NHS vehicles - inappropriately filling their own vehicles
g) Misuse of credit card for NHS use
Family Health Services - Practitioners
a) Making duplicate payment claims
b) Claiming for domiciliary visits which were not taken
c) Falsifying references and qualification certificates
d) Claiming for ghost patients
e) Claiming payment for treatment which was not provided or not appropriate e.g.
Dental
- Claiming for precious metal gold crown/ inlays when non-precious was supplied
- Falsifying recalled attendance claims - claiming payment for opening the surgery after hours for emergencies when surgery was still open
- Falsifying claims for dental rates by inflating the % amount of NHS work being carried out by the practice
Ophthalmic
- Claiming for two pairs of glasses when only one supplied
- Claiming for full replacements when only repairs carried out
- Claiming for additional items e.g. tints, prisms or small frame supplements when either not necessary or not provided
- Inflating optical prescriptions to claim higher voucher values
Pharmacy
- Claiming for expensive brand name drugs when cheaper alternatives dispensed
- Claiming for smaller packs of medications when larger quantities supplied
- Falsifying and altering prescriptions
Medical
- Inappropriate claiming of contraceptive services
- Accepting payments for directing prescription forms
- Using NHS premises for private work
- GPs/ medical reception staff printing off prescriptions for drugs under patients names then deleting the transaction from the computer system, then using the drugs for their own use
- Misuse of prescribing branded names when cheaper alternatives available - inappropriate relationships with medical reps