Jim Gee: Keeping fraudsters at bay at the NHS

The offices of the NHS counter fraud and security management service offer a valuable insight into the conditions and restraints some NHS organisations work under.

Located on the seventh floor of a tower block situated in the heart of London’s gritty Elephant & Castle area, the sound of police sirens drift through the windows with alarming regularity.

It is a far cry from the plush surroundings that commercial operations often enjoy. Its location belies its immense responsibility for providing the NHS with an extra £295m in funding over the past four years. And this is just the beginning.

Sitting at the helm of the organisation is Jim Gee. A soft-spoken man, Gee deems it his personal quest in life to stop fraudsters from ripping off public finances.

So successful has he been since the health service’s anti-fraud unit was established in 1998, that the NHS counter fraud and security management service was established earlier this year. He is now responsible for protecting NHS staff and property as well.

‘Ministers saw our approach being effective in countering fraud and felt – and I agree – that it was an approach that could be applied not only to protect resources, but people and property too,’ Gee says. ‘I think it’s a logical extension. ‘Our first priority is reducing the level of violence against NHS staff, and that in itself is a major exercise when you think that we have up to 700,000 frontline staff.’

But it is in combating fraud Gee has most of his experience. Since 1998 he has presided over countless cases, with a success rate of over 90%, and saved the NHS £295m – which is a return on its original investment of 15 to 1. ‘By the end of this financial year,’ he says, ‘I think that will be up very close to £400m. That amount of money can provide an awful lot of patient care.’

And this is one of his main motivators. ‘We have an agreement that when we save money, that money is specifically spent on patient care. It doesn’t go back to the Treasury, it goes straight back into the NHS. That means that when I go home at night I feel I’ve helped to do a little bit for a very valuable organisation.’

As vice-chair of the new counter-fraud accreditation board which the government set up in 2000, Gee is in an excellent position to fight new and innovative frauds.

He admits to being ‘surprised by people’s innovation’ and ‘the extent to which fraudsters can continually come up with new types of scams in order to con public finances’. But he also boasts of the 6,000 counter-fraud specialists who have completed foundation level training, and the several hundred who have gone on to the next level.

This autumn takes the education a significant step forward with the first-ever degree level qualification. ‘We are beginning to see what’s long overdue in my view – the formation of a profession working within a clear professional, ethical framework.’

He sees the next step as setting up a formal forum structure where counter-fraud specialists from across all industries can compare notes and experiences.

On top of this, technology will play a key role in fighting fraud within the NHS. He is in advanced negotiations with software company Statistical Software Analysis. ‘It’s something we’re quite excited about,’ says Gee.

‘I would have on each of my investigators’ desks, a real time picture of what has been claimed, and what’s anonymous.

‘We have not signed a commitment yet, it could be from next year if the software gives us the best functionality and the best value for money for public funds,’ he says.

Working with public funds is another great motivator for Gee and his team. And with the government’s commitment to spend such huge sums of money on the NHS, he is distinctly aware of the pressure that is on his team to ensure as little of it as possible is lost to fraud.

‘The extra money goes hand in hand with the reforms and creating an environment where we can make long overdue changes and reduce fraud levels,’ he says.

‘I think it gives an opportunity for us to put in new, more robust systems.’

And this is certainly needed in the accounting practices of NHS organisations.

He singles out the audit function, in particular, as an area that needs attention.

‘We have come across some accounting weaknesses,’ he said. ‘I wouldn’t want to single out the organisation concerned, but … (there was) one large-scale case where a lot of money went astray, which was intended for payment to a local authority, ended up in someone’s bank account.

We are talking about hundreds of thousands of pounds.’

Gee could not provide Accountancy Age with much detail of the case because it is still ongoing, but what he does say is alarming to say the least.

‘There had been four successive (internal) audits that had signed off the system as absolutely no problem,’ he says.

‘There are certainly issues that we come across relating to the weakness of audit in the NHS. That’s something that is currently being looked at.

There are some very good people working in the area of internal audit in the NHS, but there are also weaknesses – perhaps when organisations don’t invest enough in actually buying the audit resources to do the sort of proper job that should be done.

‘I see auditors as our partners. We have a memorandum of understanding with the Audit Commission, we have guides in our manual about how the two functions – audit and counter-fraud – should interact. We need internal and external audit within the NHS to be strong so we are effective together.’

It is a worrying report of the state of audit within the NHS from someone who is in perhaps the best position of anyone to judge.

‘One option would be to have a national focus for audit in the same way as there is now for counter-fraud, providing more support and guidance, and I think auditors would welcome that,’ he says.

‘There is some very good practice out there, but it’s patchy. It’s delivered locally. There isn’t a national centrepoint, and inevitably if you have a number of different organisations providing a service, some will do it very well, some will do it not so well.

‘The counter-fraud service now has a general standard that people meet. I think I’d like to see those sorts of improvements take place in terms of audit, too.’

Whether ministers will see the same need for such an organisation when the benefits, and paybacks, are not as immediately obvious as countering fraud remains to be seen. But Gee enjoys a direct line to senior ministers, so he will no doubt test out his powers of persuasion over the next few months.

Directors of finance are another key to Gee’s vision of how the NHS fraud team should operate. He says he has seen upwards of 500 FDs over the course of the past four years and sees them as critical if his vision is to prove successful. ‘Our legal framework dictates that local counter-fraud specialists report to finance directors. So, local counter-fraud specialists immediately have high-level support within any NHS organisation, which I think is important,’ he says.

‘We have provided seminars to give them skills and knowledge, and yes, we’ve had a very good relationship. I think they felt that perhaps, unlike other initiatives in the NHS, we were going that extra mile. We were bothering to come out and talk through the issues, answering their questions and ensuring they had the skills to play their part,’ he says.

Although this relationship has allowed Gee to successfully reduce fraud within the NHS by 40%, he is by no means complacent. ‘There are quite a few people in my area of work who ended up being legends in their imagination,’ he says. ‘Complacency is the worst enemy. There are always people coming up with new types of fraud, being quite innovative, and you must be aware of that.’

His message is clear. Invest in counter-fraud measures, and the benefits will be realised. So another of his main objectives is to persuade local NHS organisations to invest appropriately locally.

‘Locally, investment has gone up by each individual NHS organisation across the country by an average of 800% since 1999,’ he says. ‘But that is still relatively low. I want to persuade those determining local budgets that just as there has been a return of 15 to 1 nationally, they could obtain an equivalent return.

‘I want to see, by the end of 2005/2006, a further 50% increase in that investment.’

A 40% reduction in fraud and a 15 to 1 investment return. Where was the money going?

  • Conspiring with a GP, a pharmacist submitted bogus prescriptions for reimbursement with a value of more than £1m
  • Fraudulently generating fees for emergency opening, a pharmacist claimed to have been called out more than 400 times in a month
  • A dentist claimed £212,000 over two years by submitting claims for patients who did not exist
  • A dentist made duplicate claims for patients, making slight changes to their names, with a total value of more than £70,000
  • A dispensing GP issued bogus prescriptions for residential home patients over several years, with a value of more than £700,000
  • Following a doubling of the amount paid for night visits, one GP’s claims rose from under 200 visits per year to 500, but the additional visits had not been made
  • Claims were made relating to 23 patients supposedly living in a one bedroom flat owned by GP involved
  • A senior specialist falsified employment agency timesheets while working full time for an authority, generated £46,000 over five years
  • Investigation into one NHS Trust revealed more than £380,000 in claims for duty payments and hours worked, with no evidence that work had been done.

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