Counter Fraud

Arrangements for tackling fraud in the NHS were established in 1998 when it was recognised that fraud was a major issue for the NHS. NHS fraud is committed by staff, professionals, patients, contractors and managers but the fact is, no matter who it is committed by, it is damaging the Health Service as funds are being diverted away from patient care. 

On the 1st November 2017 a new special health authority charged with identifying, investigating and preventing fraud and other economic crime cross the NHS in England was launched. The NHS Counter Fraud Authority replaces the work undertaken by NHS Protect. 

The NHS Counter Fraud Authority is focused entirely on counter fraud work, and is independent from other NHS bodies and directly accountable to the Department of Health.

The purpose of the NHS Counter Fraud Authority is to lead the NHS in protecting its resources by using intelligence to understand the nature of fraud risks, investigate serious and complex fraud, reduce its impact and drive improvements.

The NHS Counter Fraud Authority have estimated that losses to fraud and other economic crime in the NHS exceeded £1.29 billion. These are funds that if available could pay for over 40,000 staff nurses, or to purchase over 5,000 frontline ambulances. 

To help combat fraud, the ICB is required to have a nominated Counter Fraud Specialist (CFS) who is dedicated to investigating fraud and implementing the national fraud strategy. To date, the work of CFSs around the country has found fraud in every area of the NHS and the work that they have undertaken has resulted in hundreds of millions of pounds being recouped and many fraudsters being prosecuted. 


  • Use of false qualification certificates and references in order to gain employment;
  • Claiming for hours not worked;
  • Working whilst off sick;
  • Claiming for travel and other expenses not incurred;
  • Managers obtaining goods and services for personal use;
  • Creation of ghost employees

GP Contractors

  • Creating ghost patients;
  • Claiming for services provided to ghost employees including production of false prescriptions;
  • Claiming for services not provided (enhanced services);
  • Raising false prescriptions for self-medicating;
  • Accepting bribes to register overseas visitors.

Other Contractors

  • Pharmacists claiming for medication not dispensed;
  • Pharmacists claiming for services not provided;
  • Failure to declare prescription charges collected;
  • Creation of claims for ghost patients – (dentists and opticians)
  • Dentists claiming for higher number of Units of Dental Activity than provided;
  • Optician claiming NHS allowances for individuals who are not entitled.


  • Amending prescriptions to gain additional medication;
  • Gaining multiple registrations with GP’s in order to obtain additional medication;
  • Overseas visitors using false documents in order to gain NHS services;
  • Patients selling their medication.
  • Newspaper Articles of Successful Prosecutions

Fraud and related criminal acts

The following list details offences which may constitute or result in a criminal act. These are mostly prosecutable under the Theft Act 1968, the Fraud Act 2006, the Forgery and Counterfeiting Act, the Criminal Law Act and the Bribery Act.

  • Theft
  • Making a False Representation
  • Failure to Disclose Information
  • Abusing Position to Gain
  • Gaining a Pecuniary Advantage
  • Misappropriation of funds
  • Corruption
  • Bribery
  • Conspiracy
  • Extortion
  • Receiving a Wrongful Credit
  • Money laundering
  • Identity Theft Extortion
  • Misappropriation of Funds
  • Forgery

The above is not an exhaustive list but contains the type of criminal acts that we may experience in the NHS. In terms of each case a judgement will need to be made in determining whether a person’s actions constitute a potential criminal act. For any case that is investigated by the CFS, advice as to whether a criminal act has been committed is always obtained from the Crown Prosecution (CPS). This is the body that prosecutes a case on behalf of the NHS.

Bribery Act 2010

On the 1st of July 2011 the Bribery Act came into force. The Bribery Act applies to all commercial and NHS organisations and provides a new consolidated scheme of bribery offences.

NHS Herefordshire and Worcestershire ICB is against any form of bribery and is committed to the terms and obligations imposed by the Bribery Act. It is a duty of all our staff to consider any hospitality or gifts offered to them, inform their line manager of the offer and to declare any such hospitality on the Gift and Hospitality Register, including hospitality declined.

When entering into contracts with organisations, the ICB adopts best practice in how it contracts for the purchase of goods, services and supplies and follows the NHS standard terms and conditions of contract for the purchase of goods and supplies.

What is Bribery?

The Bribery Act reforms the criminal law of bribery, making it easier to tackle this offence proactively in the public and private sectors.  In July 2011The Bribery Act came into force and introduced three main bribery offences:

  • Offering, promising or giving a bribe to another person;
  • Requesting, agreeing to receive or accepting a bribe;
  • Failure of a commercial organisation to prevent bribery (Corporate Offence).

The Corporate Offence is a strict liability offence and an organisation and its senior management can be found guilty of attempted or actual bribery on the organisation’s behalf, if the organisation fails to have in proper procedures in place to prevent bribery taking place.

Like the Fraud Act the Bribery Act also imposes strong sentences on conviction. The first case that was heard in Court under the new act related to receiving a £500 bribe for which the defendant was sentenced to 6 years in prison.

Information for witnesses

You may be required to be a witness because you have seen or been in contact with an aspect which relates to an investigation which is being conducted on behalf of the ICB either by the CFS or the police.

Under the requirements of the ICBs Fraud and Corruption Policy, all members of staff are required to co-operate with any fraud investigation and provide evidence or be a witness. Failure to co-operate with an investigation by a member of staff, may result in disciplinary action.

All staff who are required to be a witness will be fully supported by the CFS and ICB.

Reporting a fraud

If you suspect that a fraud is being committed it is most important that it is reported. In the first instances this must be to the CFS. If you are unsure as to whether the circumstances of your concern is fraud or not, this is not a problem, the CFS can be contacted and they will provide advice.

Alternatively, in Pauls absence please contact:

Craig Bevan-Davies, Assistant Director – Anti Crime Services

Tel: 07785 445905


Tel: 07545 502400

Matthew Curtis, Anti-Crime Team Manager

Tel: 07920 138 329


When reporting a fraud this can be made directly or anonymously, however, it is very important that as much information as possible about the matter is provided to the CFS otherwise it may not be possible to investigate the matter.

To assist with ensuring that you include relevant information the attached fraud referral form should be completed, however the CFS will also accept fraud referrals by telephone or by email.

Alternatively, if you do not wish to report your concern to the CFS directly, a fraud referral can be made using the National Fraud and Corruption Reporting Hotline - 0800 028 4060.

Please contact our local counter fraud specialist, Paul Westwood if you would like to raise a concern or discuss any suspicions you may have relating to a potential fraud incident. Paul can be contacted using the following:

Tel: 07545 502400


Alternatively use the following link or email address to contact 360 Assurance who are our Counter Fraud and Security Management providers:


ICB staff personal data such as contact details may be provided to bodies responsible for auditing, administering public funds or where undertaking a public function for the purposes of preventing and detecting fraud. This is done in line with the Cabinet Office’s National Fraud Initiative, a data matching exercise that is carried out with statutory authority under Part 6 of the Local Audit and Accountability Act 2014.