Fraud, bribery, corruption, and other illegal acts committed to obtain financial or professional gain, cost the NHS, and those providing NHS services, billions of pounds every year. It is estimated that the cost to the NHS is around £1.3 billion per annum, as per the NHS Counter Fraud Authority, who assess that to be enough money to pay for over 5,000 frontline ambulances or 40,000 staff nurses.
The ICB expect all our staff and suppliers to operate in accordance with our values and policies, and to have the best interests of our service users in mind. We are committed to the elimination of fraud, bribery, and corruption, to the rigorous investigation of any such allegations and to taking appropriate action against such individuals that includes criminal prosecution and recovery of losses as a result of any criminal act. Further details can be found in the ICB’s Anti-Fraud and Bribery Policy.
Fraud
Fraud happens when someone makes a deliberate attempt to dishonestly make a gain for themselves or another, or cause a loss, or risk of a loss, to another. This may include any person who makes a false representation or dishonestly fails to disclose to another person information which they are under a legal duty to disclose, or commits fraud by abuse of position, including any offence as defined in the Fraud Act 2006. Examples of the three main fraud offences are provided below.
- Fraud by false representation- This is the most common type of fraud investigated within the healthcare sector. This normally involves a false declaration being made, such as working elsewhere whilst on sickness absence from a substantive post. The staff member has made a representation that they are too sick to work, but is then undertaking work elsewhere, whether that is in the NHS or otherwise.
- Fraud by failure to disclose- This could be relating to any information where there is a legal duty to disclose. For example, failing to disclose a criminal record, anything that could affect a Disclosure and Barring Service (DBS) checks or right to work status.
- Fraud by abuse of position- This is when someone abuses their position of authority against another person or their employer, for personal or financial gain, or to cause loss to another. Essentially, those who know how to use the systems, but ultimately abuse them too. For example, an individual in a management position who uses their knowledge and authority to divert approved payments into a bank account in their name.
Bribery
A bribe is any inducement, financial or not, to encourage or reward someone to do something they should not do. It is an offence to give or receive a bribe, or even offer or agree to accept a bribe, even if the bribe is never paid. Bribery does not have to involve cash, and the corrupt person may not benefit directly from their deeds, however, they may be unreasonably using their position to give some advantage to another. The three main offences under the Bribery Act 2010 most relevant are:
- Giving a bribe – offering, promising or giving a bribe to another person for them to perform a relevant function or activity improperly;
- Receiving a bribe – Requesting, agreeing to receive or accepting a bribe to perform a function or activity improperly; and
- Corporate offence – failure of a commercial organization to prevent bribery.
Some common forms of bribery include cash, facilitation payments, gifts, hospitality, political donations, charitable contributions, enhanced commissions, and employment of friends or family.
Conflicts of interest are also closely linked to the offences of bribery. NHS England define a conflict of interest as, ‘a set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold’. As such, the ICB has a responsibility to safeguard their interests and ensure any conflicts of interest are managed appropriately. Further details can be found in the ICB’s Managing Conflicts of Interest (including Gifts & Hospitality)
The ICB procures goods and services ethically and transparently with the quality, price and value for money determining the successful supplier/ contractor, not by receiving (or offering) improper benefits. No person representing the ICB or involved in the procurement of goods or services may accept any bribe or other inducement, either personally or on behalf of the organisation, which seeks to influence/ or may be perceived to influence, any procurement decisions. The ICB will not engage in any form of bribery. The ICB, all employees and suppliers are required to comply with the Bribery Act 2010.
The ICB has a zero-tolerance approach towards fraud, bribery and corruption supports our reputation for honesty and ethical practice and instils confidence in our service users and the wider public. The ICB would like to re-affirm their commitment to ensuring that the ICB is free from fraud, corruption, or bribery and that all staff are aware of their responsibilities in relation to the prevention of fraud, corruption or bribery.
Reporting Concerns
Suspicions of fraud and bribery can be referred by staff, patients, visitors or any others in instances where the ICB may have been defrauded either internally or externally. If you have any suspicions or concerns, please talk to the ICB’s Local Counter Fraud Specialist (LCFS) as soon as possible; they will be able to provide you with appropriate advice and guidance with any issues relating to fraud or bribery. It is important to remember that your concerns may be important to prevent on-going fraud being committed against the ICB and to prevent funds being diverted away from patient care and should be shared with LCFS, who will advise on the next steps.
We are committed to treating those who raise concerns with respect and will not tolerate retaliation against those who make a report in good faith. All concerns reported will be treated in the strictest confidence and any information will be professionally assessed and evaluated.
Contact NHS South West London ICB’s Local Counter Fraud Specialist:
Alternatively, you can pass the information to:
The NHS Counter Fraud Authority at www.cfa.nhs.uk/reportfraud or by calling 0800 028 4060 (available 24/7).
National Fraud Initiative
The ICB are required to protect the public funds we administer. We may share information provided with other bodies responsible for auditing or administering public funds, in order to prevent and detect fraud. The Cabinet Office is 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 determine the extent of the match. This is usually personal information. Computerised data matching allows potentially fraudulent claims and payments to be identified. Where a match is found it may indicate that there is an inconsistency which requires further investigation. No assumption can be made as to whether there is fraud, error or other explanation until an investigation is carried out. LCFS supports the ICB with reviewing these matches.
We participate in the Cabinet Office’s National Fraud Initiative: a data matching exercise to assist in the prevention and detection of fraud – see guidance https://www.gov.uk/guidance/taking-part-in-national-fraud-initiative
The processing of data by the Cabinet Office in a data matching exercise is carried out with statutory authority under its powers in Part 6 of the Local Audit and Accountability Act 2014. It does not require the consent of the individuals concerned under data protection legislation or the General Data Protection Regulation (GDPR). For further information on the reasons why it matches particular information, see https://www.gov.uk/government/publications/fair-processing-national-fraud-initiative/fair-processing-level-3-full-text
For further information on data matching at the ICB please contact our Local Counter Fraud Specialist. Further information on how the NFI has assisted the NHS and other public sector organisations can also be found at https://www.gov.uk/government/publications/national-fraud-initiative-case-studies/nfi-public-sector-case-studies