Countering fraud

Fraud against the NHS means that the money intended for patient care, and funded by the taxpayer, ends up in the pockets of those who did not legitimately earn it. It means fewer resources are available to be spent on frontline health services such as patient care, health care facilities, doctors, nurses and other staff.

Fraud, bribery, corruption and other illegal acts committed to obtain financial or professional gain, cost the NHS billions of pounds every year. In 2016-17 it was estimated that the cost to the NHS was around £1.25 billion per annum, as per the NHS Counter Fraud Authority, who assess that to be enough money to pay for over 40,000 staff nurses or to purchase over 5,000 frontline ambulances.

The CCG is committed to maintaining an honest, open and well-intentioned approach to best fulfil the objectives of the NHS. This means the CCG operate a zero-tolerance approach to fraud and bribery. Such conduct, at any level, is unacceptable.

The CCG ensures that there are effective controls in place throughout the organisation, including stringent policies and internal systems to prevent and detect bribery, in accordance with the Bribery Act 2010, and to counter fraud by ensuring compliance with the NHS Counter Fraud Authority Standards for Commissioners.

What is fraud?

Fraud happens when someone makes a deliberate attempt to dishonestly make a gain for themselves or another or cause a loss to another. This may include any person who makes a false  representation or dishonestly fails to disclose to another person information which they are under a legal duty to disclose, or commits fraud by abuse of position, including any offence as defined in the Fraud Act 2006. Examples of NHS fraud offences are provided below. Further information can be found in our Anti-Fraud and Anti-Bribery Policy.

What does NHS Fraud look like?

  • By health professionals: Fraud by NHS professionals includes claiming for treatment or services not provided (e.g. Medicines Use Reviews at pharmacies, dental treatment or optical services not carried out) and working elsewhere while on sick leave.
  • By managers and staff: Fraud by NHS managers and staff includes submitting fraudulent claims for grants and payments (e.g. false or inflated travel or subsistence claims, and fraudulent applications for funding and training).
  • By contractors and suppliers: Contractor and supplier fraud includes charging for items of a higher quality or greater quantity than those supplied and using inappropriate tendering processes.
  • By patients: Patient fraud includes claiming for free or reduced cost treatment and services when not entitled and using aliases to get prescription drugs.

The NHS Counter Fraud Service wants to hear from you if you have any suspicions of fraud.  You can find their contact information on the right hand side of this page.

What is bribery?

Bribery refers to the giving or receiving of an inducement, in return for a person committing an improper function. It is an offence to give or receive a bribe, or even offer or accept, even if the briber is never paid. A bribe is any inducement, financial or not, to encourage or reward someone to do something they should not do. Further information can be found in our Anti-Fraud and Anti-Bribery Policy.

What can I do?

The first steps are being aware of the risk and remaining vigilant. You should also know how to report any suspicions or concerns you may have about fraud and/or bribery.

Visit the NHS Counter Fraud Authority website for more information and examples of recent cases.