Every penny lost to fraud impacts on the health service

Date published: 16 November 2015

All organisations suffer as a result of fraud and the health service is no exception.

Health Service Fraud Image

That is the message from the Business Services Organisation (BSO) as they lend their support to International Fraud Awareness Week (16 - 20 November 2015).

During the week, Counter Fraud Services (CFS), part of the BSO, will lead in delivering a range of activities across the Health and Social Care (HSC), to promote the zero tolerance fraud message and to raise awareness among both HSC staff and the wider public of the detrimental impact fraud can have on health service resources.

Health Minister Simon Hamilton said: "While the vast majority of people who work for or use Health and Social Care (HSC) services in Northern Ireland are honest, there are a minority of individuals who attempt to defraud our health service.

"HSC services are primarily for the benefit of the people who live in Northern Ireland, yet there are patients who provide false information in order to access free health care. This has a direct impact it has on the delivery of frontline services.

"In conjunction with other HSC organisations, CFS work to prevent, investigate and detect fraud. I would encourage everyone within the HSC to learn how to recognise and report fraud. I also urge the public to ensure they are aware of what they are entitled to avail of or entitled to make use of.At a time when the healthcare budget is facing significant challenges, it is important we send a clear message that fraud will not be tolerated."

CFS has undertaken a number of initiatives to identify patients who may be accessing services free of charge to which they are not entitled. To date, these projects have resulted in over 400 people being referred for removal from the GP register, at a potential saving of almost £1 million each year to HSC.

Every penny lost to fraud impacts on the health service, meaning less is available to be spent on frontline services. It is estimated that:

  • £4 could pay for a meal to be delivered to a client’s home
  • £15 could pay for one hour of domiciliary care
  • £400 could pay for the drugs used in a chemotherapy session
  • £960 could pay for one cataract procedure
  • £15 million could fund 500 nursing posts

Mark Harvey, CFS Assistant Director said: "By its very nature fraud is a hidden crime and there is no 100% accurate way of calculating the amount of money lost to fraud. Indeed, a variety of academic studies in this area have presented hugely differing estimates. Here at Counter Fraud Services we are very much focused on raising awareness amongst staff and the public that every penny lost to fraud has a detrimental impact on the delivery of front line services. We continue to proactively tackle this issue."

In the last two years, there has been a 30% increase in the number of fraud cases investigated by the fraud unit, with the team currently investigating over 100 ongoing fraud cases. For those cases pursued through the courts, the team have a 96% conviction rate.

In the last four years, the number of prescription fraud incidents reported to CFS has increased by some 677%. CFS Investigation team has worked closely with the HSC Board and practitioner groups to develop comprehensive advice and guidance in this area and in the last eighteen months, 159 incidents have been reported resulting in 96 investigations. Nineteen prosecutions have been secured in this period with a number of cases currently awaiting trial.

The BSO Information Unit estimates that loss to patient fraud and error in dental and ophthalmic services in 2014/15 was some £3.7m. This year, CFS has launched a regional ‘help with help costs’ campaign aimed at tackling this issue. They will also be contacting over 7,000 patients who may have inappropriately claimed exemption to health service charges, seeking proof of entitlement to exemption and, where appropriate recovering the cost of the treatment. In many of these cases, penalty charges will be applied and, in some cases, court action taken to recover outstanding debts.

Mr Harvey continued: "Counter Fraud Services undertake a wide range of fraud prevention, detection and investigation work. Our team of dedicated specialist fraud investigators thoroughly investigate all cases of suspected fraud referred to us by HSC organisations or whistleblowers.

"Our newly established fraud detection team carry out a range of proactive projects, embracing new approaches in data analytics to tackle issues such as eligibility to healthcare and potential fraud and/or waste across the HSC.

"Preventing and detecting fraud is undoubtedly a challenge but we hope that by increasing staff awareness and understanding of the issue, recognising its harmful impact and reporting instances of suspected fraud wherever it may occur, we can all contribute to preventing this unacceptable drain on healthcare resources."

To report an incident of suspected fraud, please call the HSC Fraud Hotline on 0800 096 33 96 or send a report online.

Notes to editors: 

1. Counter Fraud Services are responsible for the investigation of all cases of suspected fraud across Health and Social Care, Northern Ireland.

2. Examples of types of fraud

Fraud against HSC by patients includes:

  • falsely claiming to be resident in Northern Ireland to access free HSC treatment
  • attempting to obtain prescription drugs by deception eg using an alias

Fraud by staff against HSC includes:

  • falsifying qualification to gain employment
  • submitting timesheets for hours not worked
  • submitting travel claims for inflated mileage or journeys that were not work-related
  • abuse of sick leave eg working for an agency while on sick leave
  • misuse of HSC resources for personal gain

Fraud by practitioners includes:

  • claiming for treatment not provided
  • charging for items of a higher cost than those supplied
  • charging patients privately while also claiming reimbursement from the health service

3. You can follow Counter Fraud Services on Facebook at BSO Counter Fraud Services or on Twitter @bsocfs.

4. Media enquiries about this press release to DHSSPS Press Office on 028 9052 0074, or out of office hours contact to Duty Press Officer via pager number 07699 715 440 and your call will be returned.

Follow us on Twitter @healthdpt

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