Report finds NHS fraud referrals up by 17 per cent

A benchmarking analysis of more than 80 NHS organisations has found that the number of cases referred for fraud investigation has risen by 17 per cent in the last year.

RSM, which delivers counter fraud services to the NHS bodies surveyed, recorded 364 reactive fraud referrals from its clients in 2014-15, up from 311 in the previous year.

The nature of the fraud referrals in 2014-15 were broadly similar to last year, with more than 70 per cent relating to workforce fraud, such as misrepresentation of qualifications, skills or experience, timesheet fraud, working while on sick leave and expenses claim frauds. Other reported frauds related to finance, procurement or patient fraud.

Many referrals occurred during seasonal holiday periods when those allegedly committing fraud were away on leave and unable to cover their tracks, or when colleagues felt more comfortable about reporting concerns.

The report also found that there has been a considerable increase in allegations of identity fraud particularly within the recruitment process.

David Foley, RSM’s Head of Fraud Risk Services said:

‘NHS Protect has reported that the total value of identified fraud in the NHS during 2014/15 was just under £12m but the figure for unidentified fraud will be far higher.

‘The figures in our report appear to show a rise in the instances of fraud within the NHS but they also indicate an improvement in the awareness and detection of fraud.

‘NHS staff, particularly in Human Resources departments, have a key role to play in identifying and reporting instances of fraud. Building knowledge among staff to help them identify instances of fraud, encouraging them to take ownership of scarce resources and to be confident to report concerns are key elements in trying to tackle fraud in the NHS.

‘One of the more troubling aspects of our report is that fraud involving identity crime and entitlement to work in the UK is continuing to rise and the NHS has to be particularly mindful of the risks associated with this form of fraud.’

In 2014-15, RSM helped secure for recovery or prevent losses of £688,000, and its work resulted in seven criminal sanctions, five instances of repayment of funds and 24 disciplinary sanctions, including 12 dismissals.

Click here for the full Fraud in the NHS report.