How do we detect and prevent fraud?
The overwhelming majority of patients and professionals would not dream of stealing from the NHS, but a small minority of patients and health service staff do just that. Every time they commit fraud, patient care suffers. The law abiding public have the right to expect the NHS to safeguard public funds and to crack down on those committing fraud.
Fraud in the health service takes many forms. Often it is relatively low value and opportunistic. Sometimes, it is high value and committed by skilled criminals.
Patient fraud includes wrongful claiming of exemption from fees, alteration of prescriptions and more recently, using aliases to obtain controlled drugs.
The NHS Counter Fraud and Security Management Service (CFSMS) exists to fight NHS fraud. The counter fraud strategy intends:
- To reduce fraud to an absolute minimum within a set timescale
- To put in place arrangements to hold fraud at a minimum level permanently; and to target more NHS resources at providing better patient care.
The most powerful incentive to tackle the problem of NHS fraud is the need to ensure resources are not lost to fraud but are used for better systems and services delivering improved patient care. Not acting against fraud, can undermine the reputation, integrity and professionalism of the NHS and perceptions about the quality of the services it provides leading to a loss in public confidence. Success in combating fraud depends on the co-operation and involvement of both patients and staff at all levels within the NHS.
South Central Ambulance Service NHS Foundation Trust also has its own Local Counter Fraud Specialist (LCFS). To discuss any concerns or to report a suspicion regarding NHS fraud, contact Tracey Spragg, our Local Counter Fraud Specialist on 07870 582196 or email: firstname.lastname@example.org.
You can also report any suspicious activity to the National Fraud and Corruption reporting telephone line on 0800 0284060.
National Fraud Initiative - Fair process notice
The South Central Ambulance Service NHS Foundation Trust is required by law to protect the public funds it administers. It may share information provided to it with other bodies responsible for auditing or administering public funds in order to detect and prevent fraud.
The Audit Commission appoints the Auditor to audit the accounts of the Trust. It is also responsible for carry out data matching exercises.
Data Mapping involves comparing computer records held by one body against other computer records held by the same or another body. This is usually personal information. Computerised data matching allows potentially fraudulent claims and payments to be identified. Where a match is found it indicates that there is an inconsistency which requires further investigation, no assumption can be made as to whether there is fraud, error or other explanation until an investigation can is carried out.
The Audit Commission currently requires us to participate in a data matching exercise to assist in the prevention and detection of Fraud. We are required to provide particular sets of data to the Audit Commission for matching each exercise, and these are set out in the Audit Commissions Handbooks, which can be found at www.audit-commission.gov.uk/nfi
The use of data by the Audit Commission in a data matching exercise is carried out with statutory authority under its powers in Part 2A of the Audit Commission Act 1998. It does not require the consent of the individuals concerned under the Data Protection Act 1998.
Data matching by the Audit Commission is subject to a code of practice, this may be found at www.audit-commission.gov.uk/nfi/codeofdmp
For further information on the Audit Commission's legal powers and the reasons why it matches particular information, see the links to the above website pages or contact the Information Governance Manager on 01962 892690.