One in five fraud cases in the NHS relates to employees who are carrying out unauthorised work while on paid sickness absence, according to data from more than 80 NHS organisations analysed by Baker Tilly.
In the year ending 31 March 2014, 20% of the 311 fraud cases referred to the professional services firm for investigation related to staff working for other organisations while on sick leave from the NHS, a one per cent rise over the same period last year. The next most common reason for referral was the theft or misuse of NHS resources (11%), followed by staff altering or falsifying timesheets (9%).
In total, 219 of the 311 fraud referral cases (70%) related to workforce fraud, 54 (17%) to finance fraud, 20 (6%) to procurement fraud and 18 (6%) to patient fraud.
The total number of fraud cases was down by nine per cent on the previous year, as the emergence of Clinical Commissioning Groups appears to have led to a reduction in fraud referrals nationally, with the risks of fraud in primary care shifting in the main to the areas covered by NHS England, such as contractors and suppliers.
The main source of referrals were members of staff working in Human Resources departments who are playing a key role in efforts to tackle NHS fraud.
The benchmarking analysis has been carried out by Baker Tilly’s Fraud Risk Service which provides counter-fraud services to more than 80 NHS clients. The findings are used to provide a national overview of the fraud investigation types, trends and themes to help NHS client organisations compare their performance and review their approach to counter fraud.
Fraud costs the UK an estimated £52 billion every year according to the latest Annual Fraud Indicator, and the Audit Commission has estimated that the value of payroll fraud alone within the public sector to be around £335 million. Examples of payroll fraud include employees claiming overtime for hours not worked, false expense claims and unauthorised changes to an organisation’s payroll system, such as an employee adding ghost employees who either do not exist or do not work for the organisation.
David Foley, Head of Fraud Risk Services at Baker Tilly said: “The current economic climate and the reorganisation of NHS services means some employees may be suffering from job insecurity and possible resentment over pay freezes. In addition, the NHS provides favourable employment terms and conditions, such as sickness pay entitlement, which unfortunately can become abused by the dishonest minority. These conditions can increase fraud risk, so NHS organisations need to be vigilant to this ‘threat from within’.
“Our report provides a snapshot of some of the main fraud risks facing the NHS now, and highlights emerging threats such as cyber enabled fraud, with a view to helping organisations review, and if necessary alter, their approach to counter-fraud to meet an evolving modern NHS.”
Baker Tilly is one of the leading providers of counter fraud services to NHS sector organisations in the UK and it works closely with NHS Protect. During 2013-14, prosecutions following its counter-fraud investigations resulted in significant prison sentences for some of those found guilty, and the firm helped its clients recover over £400,000.