Counter fraud

Anti-fraud and corruption

The NHS Counter Fraud Authority estimates that in 2016-17 losses to fraud and other economic crime in the NHS exceeded £1.25 billion. These are funds that if available, could pay for over 22,000 GPs or purchase over 5,000 frontline ambulances.

Birmingham and Solihull Clinical Commissioning Group has an anti-fraud team which is provided by CW Audit services. The role of the anti-fraud team is to help protect the resources of the CCG by raising awareness of fraud, bribery or corruption affecting the NHS and, when necessary, investigating any offences committed against the CCG. The team is made up of a number of dedicated anti-fraud specialists who, between them, have significant experience of combating fraud in the public sector.

How to report fraud

There are a number of ways that you can report any concerns you have concerning the CCG:

  • Contact the CCG’s NHS Local Counter Fraud Specialist, Richard Loydall: This email address is being protected from spambots. You need JavaScript enabled to view it., or call 024 76 536871 or 07887 557496
  • Call the NHS national fraud reporting line (supported by Crimestoppers): 0800 028 40 60
  • Report your concerns via the NHS online fraud reporting tool

All concerns will be treated in the strictest of confidence and can also be made anonymously. A thorough investigation will be carried out and, where appropriate, the offenders prosecuted. It may be necessary to involve the police in any investigation.

What is fraud?

Fraud involves some sort of dishonesty or scam, which tries to get money or another sort of financial benefit from someone or an organisation by dishonest means.

What is bribery?

Bribery involves offering, giving, seeking or receiving some sort of benefit (either in cash or in kind) in return for getting a benefit that wouldn’t otherwise have been obtained e.g. securing the award of a contract to a particular supplier in return for a payment.

How could fraud happen in the NHS?

There are many ways in which fraud has been known to occur in the NHS.  Examples include:

  • An employee claiming mileage expenses for journeys that they didn’t make
  • An employee going off sick, obtaining sick pay, but then working for another employer at the same time
  • Lying about qualifications or experience, in order to obtain a job that the person isn’t qualified to do
  • External bodies sending in invoices for goods or services that weren’t supplied, or over-charging for what was supplied
  • False ‘change of bank account’ requests, to try and divert payments to incorrect accounts
  • Patients altering prescriptions in order to obtain medication that they weren’t prescribed
  • Dentists or opticians claiming to have treated patients who don’t exist, or who do exist but who never had the treatment that is being claimed for
  • Pharmacist claiming payment for dispensing expensive brand name drugs, but actually supplying cheaper generic drugs

NHS Counter Fraud Authority  

The NHS Counter Fraud Authority is a special health authority charged with identifying, investigating and preventing fraud and other economic crime cross the NHS in England. It is focused entirely on counter fraud work and is independent from other NHS bodies and directly accountable to the Department of Health.

The purpose of the NHS Counter Fraud Authority is to lead the NHS in protecting its resources by using intelligence to understand the nature of fraud risks, investigate serious and complex fraud, reduce its impact and drive improvements.

What should I do if I suspect an offence is taking place?

If you suspect an offence is taking place you must:

  • Make a note of your concerns in as much detail as possible
  • Note all relevant details, such as what was said, the date and time, names of all parties involved, or a description of individuals involved
  • If legal to do so, keep a record or copy of any documentation that arouses your suspicion
  • Report your concerns immediately, as any delay might cause the CCG to suffer further financial loss
  • You can report your concerns directly to the anti-fraud team - see contact details above.

Do not:

  • Investigate it yourself, as all evidence must be gathered in a legally admissible manner
  • Confront the individual
  • Convey your suspicions to anyone other than those with proper authority to investigate
  • Do nothing!