COUNTERING FRAUD AND BRIBERY Camden CCG Patient and Public Engagement Meeting Gemma Higginson, 6 June 2016

What is fraud?

• For an offence to have occurred, the person must have acted dishonestly with the intent of making a gain for themselves or anyone else, or inflicting a loss (or a risk of loss) on another.

• Person must have acted dishonestly

• Three main offences

• All require the element of dishonesty to be established.

Offences under the Fraud Act 2006.

Fraud Act 2006

Abuse of position

Failure to Disclose

False representation

The Bribery Act 2010

The offences • This first general offence is referred to as

active bribery and this constitutes the offering, promising or giving of a bribe

• The second general offence is referred to as passive bribery and constitutes requesting, agreeing to receive or the accepting of a bribe

• There is also a specific offence of bribing a foreign public official

Bribery Act

Give a bribe

Receive a bribe

Bribe a foreign public official

Negligently fail to

prevent a bribe

Penalties: individual and corporate

• Maximum of 10 years imprisonment

• Unlimited fine

• Potential risk of disbarment from EU

tendering

• Directors struck off

• Massive reputational damage

Role of the Local Counter Fraud Specialist

Strategic Governance

Inform and Involve

Hold To Account

Prevent and Deter

.

Examples of NHS fraud cases

Prescription fraud • A CCG undertook a fraud investigation into a long standing and trusted member of

the reception team at a GP Practice, who abused her position by taking advantage of poor IT policy procedures and adherence to those procedures.

• Raised false prescriptions on elderly patients’ records who were in receipt of repeat

prescriptions. • Supplied the fraudulent prescriptions to unknown 3rd parties who then presented

them at out of area pharmacies. • Sentenced to 12 months Conditional Discharge and ordered to pay costs and

compensation.

Examples of NHS fraud cases

Doctor – falsifying records

• A doctor who stole over £62,000 from the NHS was sentenced to 9 months’ imprisonment (suspended for 18 months) and must pay £50,000 costs.

• He admitted to falsifying the records of 1,703 patients to hit targets and increase

payments from the NHS to his practice and pleaded guilty to two offences under the Fraud Act.

• In just three days he manipulated the practice’s patient records system over 7,000 times in order to hit financial targets. He falsely claimed for patient checks he had not carried out.

What can You do?

DO Tell someone

Be aware of fraud issues

Make a note of your concerns

Keep a record or copy any documentation that arouses your suspicion

DO NOT x Confront the individual

x Try to investigate the matter yourself

x Delay

x Contact the police directly

x Convey your suspicions to anyone other than those with proper authority to investigate

x Do nothing

Reporting Concerns

Counter Fraud Team Gemma Higginson Kirsten Quinn Chaya-orna Diamond

: 07800 718 680 : 07436 268 340 : 07528 970 114

: gemma.higginson@rsmuk.com kirsten.quinn@rsmuk.com : chaya-orna.diamond@rsmuk.com

• Chief Finance Officer: Ian Boyle

• National Fraud Reporting Line : 0800 028 40 60

• Online reporting form at: www.reportnhsfraud.nhs.uk

• Public Concern at Work: 0207 404 6609

Thank you for your time and attention

As a practising member firm of the Institute of Chartered Accountants in England and Wales (ICAEW), we are subject to its ethical and other professional requirements which are detailed at http://www.icaew.com/en/members/regulations-standards-and-guidance. The matters raised in this presentation are only those which came to our attention during the course of our review and are not necessarily a comprehensive statement of all the weaknesses that exist or all improvements that might be made. Recommendations for improvements should be assessed by you for their full impact before they are implemented. This presentation, or our work, should not be taken as a substitute for management’s responsibilities for the application of sound commercial practices. We emphasise that the responsibility for a sound system of internal controls rests with management and our work should not be relied upon to identify all strengths and weaknesses that may exist. Neither should our work be relied upon to identify all circumstances of fraud and irregularity should there be any. This presentation is supplied on the understanding that it is solely for the use of the persons to whom it is addressed and for the purposes set out herein. Our work has been undertaken solely to prepare this presentation and state those matters that we have agreed to state to them. This presentation should not therefore be regarded as suitable to be used or relied on by any other party wishing to acquire any rights from RSM Risk Assurance Services LLP for any purpose or in any context. Any party other than the Board which obtains access to this presentation or a copy and chooses to rely on this presentation (or any part of it) will do so at its own risk. To the fullest extent permitted by law, RSM Risk Assurance Services LLP will accept no responsibility or liability in respect of this presentation to any other party and shall not be liable for any loss, damage or expense of whatsoever nature which is caused by any person’s reliance on representations in this presentation. This presentation is released to our Client on the basis that it shall not be copied, referred to or disclosed, in whole or in part (save as otherwise permitted by agreed written terms), without our prior written consent.