Fraud has become more than just a dirty word in the health year Ben Griffiths takes a close look at the counter-fraud directorate’s prescription for controlling it Fraudbusters get to work at NHS. service.
The disease has become so rife that the service’s governing body – the NHS Executive – has decided it is time to bring in specialist fraudbusters to tackle it.
Next week sees the formal launch of an NHS anti-fraud strategy. The aim of the exercise is to reduce fraud to a minimum within ten years.
Health minister Alan Milburn announced the establishment of a Directorate of Counter Fraud Services at the end of last year. Since then the fledgling unit has set about its task with gusto.
The driving force behind the unit is its new head Jim Gee, who has moved from local government to tackle a problem that costs the NHS hundreds of millions of pounds a year.
Since his arrival in December 1998, Gee has set out a strategy designed to tackle the problem head on.
The first battle in the war involved taking stock of what the NHS already knew about fraud. This has been followed by the production of a ‘comprehensive, integrated and professional’ strategy.
Once the strategy was in place, the fraudbusters set out to produce a list of aims and objectives which would prioritise action.
The key concept for the anti-fraud teams is that ‘prevention is better than cure’.
Gee explains: ‘From April 1999, we will be investing more than #4m in our counter-fraud work. We will ensure that trained accredited professionals are in place in each part of the health service, tasked with taking effective action against fraud.’
This first line of defence will be dedicated counter-fraud staff in every health body. In cases beyond their capabilities, regional teams will be brought in to help out. Additionally, a national mobile team will be used to tackle fraud in the highest risk areas.
The directorate is putting together a training package for all its staff to make sure that only qualified people work in counter-fraud. The training will in turn be assessed to add value.
Now these processes are in place, the unit is setting out to promote what Gee terms ‘a counter-fraud culture’.
The first stage of this is a series of roadshows to take the battle to the NHS trusts. This is due to be launched on 25 February in London.
‘We will do it in a fair, balanced professional way. We have been clear about the end objectives. We will all benefit from that,’ Gee says.
NHS finance director Colin Reeves welcomes the strategy.
‘I am quite sure in terms of prevention and detection it is going to be extremely useful and I hope to see a substantial number of savings in the future,’ he says.
The Health Bill, which is currently in its second reading in the House of Lords, contains legislation to strengthen systems of professional self-regulation to ensure they are more ‘open, responsive and publicly accountable’.
The bill will also put into law several processes that will help the fraudbusters in their work.
These steps include strong powers to prevent fraudsters from working in the NHS. Additionally, there are plans for a new criminal offence of evading prescription charges. At present, this costs the NHS #150m each year. Where it is proven, this new offence will carry a fixed penalty.
‘By these means,’ adds Gee, ‘we will give the NHS the care and protection it deserves’.
SCAMS OF THE NHS FRAUDSTERS
– A dispensing GP issued bogus prescriptions worth #700,000 for residential care patients over several years
– A dentist claimed #212,000 over two years by submitting claims for non-existent patients
– An optician claimed for eye tests for dead patients
– Conspiring with a GP, a pharmacist submitted bogus prescriptions for reimbursement worth more than #1m
– A senior hospital registrar falsified employment agency timesheets while working for a health authority, generating #46,000 in fraudulent income over five years
– An investigation at one NHS trust revealed more than #380,000 in claims for duty payments and hours worked, with no evidence that work had been done
– A patient claimed more than #2,500 a year in travel expenses to an out-patient clinic.
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