Types of Fraud

Different types of fraud in the NHS

Fraud manifests itself in the NHS in a variety of ways.  Fraud is said to cost the NHS an estimated £5 billion every year.  It is important that we are all aware of the types of fraud that are committed and are not afraid to report fraudulent behaviour.

Patient Fraud

Patient fraud includes wrongful claiming of exemption from fees or travel expenses, alteration of prescriptions, and using aliases to obtain controlled drugs to name but a few.

Case Example - Andrew Cunningham, a Dragon’s Den reject, used 43 different fake identities to register with GP surgeries across the country, fooling 159 different doctors to unlawfully obtain more than 22,000 prescription drugs.  He was caught because a suspicious doctor of a Gloucestershire surgery called the hotel where Cunningham said he was staying, and there was no trace of him.  Cunningham was sentenced to a 150 hour community work order and a supervision order for 12 months.  He was also ordered to pay £4,000 in compensation and costs.

Professionals

Fraud by NHS professionals includes claiming for treatment or services not provided, undertaking private work in NHS time and using Trust equipment and materials for private work

Case Example –Pharmacist, Jonothan Edens, of Westward Road, Ebley, was jailed for two years for stealing drugs to feed a heroin habit.  The crime also cost him his £50,000 a year job at Stonehouse Pharmacy where he where he began stealing £3,000 worth of drugs.

Case Example – Sharon Head, former Manager of a Forest of Dean doctors’ surgery was given a 2 years and 9 month prison sentence for defrauding the NHS out of £95,422.  She had worked at the surgery since the age of 16.  Head abused her position by falsifying records of her own pay slips and increased her hourly wages by up to 52%.

Managers and Staff

This type of fraud involves the submission a false CV or references; false or inflated timesheets or expenses; working elsewhere whilst on sickness absence from the Trust; abuse of Trust equipment; misappropriation of funds; claims for non-existent employees; and for goods and services that are for personal use.

Case Example – Mabel Osagiede pleaded guilty to cheating the NHS out of more than £2,000 by claiming to be sick when she was doing a second job. She was working shifts as care assistant at The Orders of St John Trust at Podsmead Court while officially on sick leave from 2gether.

Case Example - Lee Sutherland embellished his CV, claiming he had a diploma in critical care to get a job with the Great Western Ambulance Service NHS Trust.  He was fined £2,000 and ordered to pay £800 towards the costs of the prosecution.

Case Example - Nurse, Barbara Davis, claimed she was visiting sick patients in Gloucestershire, but when she was placed under surveillance it was established that she was actually claiming for thousands of miles to visit her horses.

Contractors and Suppliers

Contractor and supplier fraud includes charging for items of a higher quality or greater quantity than those supplied; using an inappropriate tendering processes; false or duplicate invoices; and price fixing.

Case Example - A hospital chef tampered with the carbon copies of his timesheet and sent the agency different versions from those signed off by the Trust. In this way, he claimed payment for time when he was not on duty. The chef was sentenced to eight months’ imprisonment for deception and false accounting.

Immigration Matters

Individuals who work, or attempt to work for NHS organisations supplying false documentation ranging from false passports, visas and national insurance numbers to secure employment.

Case Example - A number of Zimbabwean nationals were employed as support workers. Following a joint operation with the LCFS and the Police all individuals were arrested and pleaded guilty to obtaining a pecuniary advantage and using a false instrument and were convicted to 12 months imprisonment.

 

Email your local counter fraud service at Fraud.Account@glos.nhs.uk