My route into this role has taken me through many different sectors. I worked in retail before studying a BSc in Criminology, Criminal Justice Studies and Law and then worked in civil litigation for four years before stepping into the world of NHS counter fraud and becoming an accredited counter fraud specialist. I am now the LCFS for Torbay and South Devon NHS Foundation Trust.
NHS England’s Tackling Fraud Bribery and Corruption Policy and Corporate Procedures states that: “All fraud, bribery and corruption (collectively referred to as economic crime) in the NHS is unacceptable and should not be tolerated. It affects the ability of the NHS to improve health outcomes for people in England, as resources are wrongfully diverted and cannot be used for their intended purpose”.
Most NHS healthcare services are commissioned under the NHS Standard Contract. Service conditions within the standard contract require providers to put in place and maintain appropriate counter fraud arrangements. Specifically, service condition 24.2 requires providers which are licensed by Monitor and NHS trusts, to take the necessary action to meet the anti-crime standards set by NHS Protect. The anti-fraud, bribery and corruption remit is delivered locally through an extensive network of professionally trained and accredited Local Counter Fraud Specialists (LCFS).
It is mandatory for each NHS organisation to have a LCFS. This seems logical considering the annual losses suffered by the NHS are estimated at £1.27 billion. This estimate represents about 1% of the NHS annual budget of £134 billion. If we consider the academic literature surrounding fraud, Button & Gee (2013) research suggests that most organisations suffer on average a 5% loss to fraud.
Therefore the role of the LCFS is extremely important to try and reduce and limit these losses as much as possible and safeguard the financial position of the organisation.
So, what does an LCFS do?
Well, broadly my role is split into four areas; strategic governance, inform and involve, prevent and deter and hold to account. These areas are all very much interlinked, but briefly:
Strategic Governance is the process of ensuring counter fraud measures are embedded at all levels.
Inform and Involve is raising awareness of fraud bribery and corruption risks and working with staff, stakeholders and the public to highlight the issue of economic crime in the NHS and consequences for those who participate.
Prevent and Deter involves testing procedures and fine tuning them to reduce their fraud risk and deter people from committing fraud. For example reviewing an expenses approval process and making it mandatory for receipts to be submitted.
Hold to account is investigating, applying sanctions and obtaining redress from those who commit fraud or bribery against the organisation. Depending on the severity this can range from an internal disciplinary action to a full criminal prosecution.
Broadly speaking, the above is either proactive (preventing the fraud from happening) or reactive (dealing with the fraud after it has happened).
So, how do we do it?
We undertake a wide range of activities to build an anti-fraud culture. We start right from the beginning reviewing policies and procedures to ensure they encompass counter fraud controls. This involves working closely with a wide variety of staff at all levels and disciplines within the organisations we work with. We run counter fraud awareness training; from an overview of fraud against the NHS for new members of staff to bespoke training to departments including HR, community nursing, cash management, and allied health professionals.
We publish and disseminate our own newsletter (Fraud Counts) which includes examples of NHS fraud cases that have gone through the judicial system. This is all to help staff know what fraud bribery and corruption are, what they look like, what they need to do if they see it and the consequences for those found to have committed fraud against the NHS. We find that, armed with this knowledge, staff are more confident at identifying fraud for what it is, feel more confident about how to report their concerns and that the small minority of staff that contemplate committing fraud will weigh up their chances and decide against it.
Testing for Fraud
The prevent and deter element of the role involves testing processes and procedures to identify possible weaknesses or “loopholes” that might allow fraud through. If you don't know what the problem is, how can you apply the right solution? Once you know the nature of the problem, you can revise the systems and processes to ensure (as best as possible) the opportunities aren't there.
This is conducted across all areas of the NHS but include timesheet fraud, false expense claims, secondary employment, staff taking paid sick leave when they are really fit for work and all areas of procurement. In conducting these reviews we frequently identify past losses but more importantly identify weaknesses that, if modified, will reduce the opportunities available to fraudsters. These proactive exercises simultaneously raise the awareness of fraud prevention with a view to also deterring future fraudsters.
The result of all of the above is that fraud will be eradicated and job done! Unfortunately not. But for those occasions when fraud is committed we have the investigatory powers to investigate and explore the appropriate sanctions.
Investigating Fraud
If a criminal investigation is pursued our powers to seize evidence, interview suspects and witnesses are similar to those of the police, but we may still ask for their help if we feel an arrest is needed or property searched.
If a fraud involves a member of staff or contractor we will take action to ensure that the NHS employer and/or the individual's professional body (such as the GMC/NMC) is informed of the issue so that the relevant disciplinary action can be taken. As part of the investigation we will take action to both punish the fraudster (imprisonment/fine/community service) and recover the money lost through the fraud.
As you can see the role is varied and requires motivation, dedication and patience in order to succeed. Fraud will always be an issue for organisations but by implementing the above strategy, the potential for fraud is reduced.
i NHS England. Tackling Fraud, Bribery and Corruption: Economic Crime Strategy 2018-2021.
ii ‘Welcome and induction pack For accredited counter fraud specialists and associated roles’
iii Gee, J. & Button, M. (2013) Counter Fraud for Competitive Advantage: The Professional Approach to Reducing the Last Great Hidden Cost. Wiley, Chichester
Fraud for Thought –
A day in the life of an LCFS
Adele Rilstone.
Welcome to Fraud for Thought, written by the Counter Fraud team of ASW Assurance who provide counter fraud services to a number of NHS organisations across the South West. Fraud for Thought aims to provide an informative and interesting discussion on some of the issues associated with fraud. This introductory article focusses on the role of the Local Counter Fraud Specialist and was written by Adele Rilstone.
Opportunity: Weak policies? Lack of checks on invoices? No checks made on spend?
Rationalisation: I haven’t had a lunch break all week so I deserve this! Everyone else does it so why not? They didn’t pay me my overtime! I see the boss knocking off early all the time!
Pressure: Need; gambling addiction, spiralling debts, financial worries, pressured by a third party. Greed; money, unaffordable lifestyle choices
Reducing opportunity is something we can all help with. Additional layers of checks such as sampling expense claims or adding a declaration to claim forms, are all simple and relatively straightforward methods to ensure that the risk the fraudster takes when committing fraud, is a significant one as they are more likely to get caught. A significant deterrent effect is also created when staff know that their activity and claims may be subject to checks. Managers don’t have to check everything; sample checks are fine!
Rationalisation is more complex as it can be influenced amongst many things, by the organisations ethics and structure. If management and the executive lead by example this will help with creating a positive anti-fraud culture where staff do not feel unfairly treated. This will reduce the opportunity for staff to rationalise their behaviour.
Pressure can be in the form of pressure from an addiction, or debt or pressure to live a lifestyle beyond your means or may be nothing more than pure greed. However high the pressure, the organisation can ensure that potential fraudsters do not have the opportunity to commit fraud by ensuring the robust policies and procedures are complied with throughout.
We can see the impact fraud and bribery has on private sector businesses; loss, layoffs, settlements, sale and potentially, the business may fail. However, what about the NHS which is just as vulnerable to fraud but not able to ‘fail’? Can we be sure in the same way that the private sector is, about what the ripples of devastation are? The impact of fraud losses aren’t quantified in such detail.
The NHS Counter Fraud Authority estimates the annual loss to fraud as £1.2 billion in 2019. Unfortunately, we know that staff are responsible for a significant proportion of these losses. Undoubtedly the losses to fraud are a contributing factor to why the word that often accompanies the NHS is “crisis”. The NHS simply cannot afford to lose £1.2 billion and be expected to keep on going – but it does. There are fewer resources and more people requiring treatment; resulting in staff working longer hours, increased pressure and reduced trust. All of which can present a risk within the fraud triangle.
It is therefore crucial that NHS staff work with their Local Counter Fraud Specialist to identify and reduce fraudulent activity that takes money away from patient care. We place considerable importance on meeting members of staff and joining in on team meetings to raise awareness of fraud; what it is and what it might look like.
Together we can make a huge difference!
Fraud prevention tips:
- Remind employees of their value!
- Ensure that whistleblowing policies are well publicised with the reporting details included
- Raise awareness with staff about what fraud looks like; working for another employer whilst off sick and falsifying timesheets or false expense claims are a few examples. Contact your LCFS to arrange a presentation or workshop.
- Report concerns to the LCFS – staff can discuss their concerns with impunity.
1 Donald R. Cressey, Other People's Money (Montclair: Patterson Smith, 1973)
Internal fraud – ie fraud committed by the employees of an organisation - is nothing new and is a well-established enemy of business and development. This Fraud for Thought article considers what influences internal fraud, before discussing the impact it has.
Organisations rely on their employees and invest considerable trust in them to fulfil their roles competently and diligently. Cressey’s fraud triangle attempts to explain the reasoning behind a person’s decision to commit fraud. The three elements, categorised by the effect on the individual, can be summarised as pressure, opportunity and rationalisation.
Fraud for Thought –
Internal Fraud
Adele Rilstone.
The Fraud Triangle
