NHS Counter Fraud and Security Management Service Division - The NHS Counter Fraud Service

The NHS Counter Fraud Service

The NHS Counter Fraud Service was set up in 1998 as part of the Department of Health under the leadership of Jim Gee. The organisation set about discovering the scale of fraud against the NHS, what types of crime were involved and how much money might be being lost to the NHS. The next step was to set up an operational department to investigate cases of fraud and help the police and Crown Prosecution Service bring them to justice.

It was discovered that fraud was being carried out by patients, NHS staff and professionals and contractors. Examples included patients using false identities to gain large numbers of prescriptions for drugs, NHS staff members claiming for shifts they had not done, managers inflating expenses and contractors such as opticians and dentists claiming for services they had not provided.

From 1999-2006 it was estimated that counter fraud work in the NHS benefited the public purse by £811 million. This could pay for 53,000 kidney transplants or 35,000 nurses for a year.

Successes include the investigations into a General practitioner who did private work while off sick from the NHS, who was jailed for 12 months, a manager at a major hospital trust who was jailed for four years for creating fake employees in order to claim their salaries and a bogus psychiatrist who faked his qualifications, jailed for ten years. He lived a lavish lifestyle which included a 5 bedroom house, 30 Armani suits and a Ferrari. Under controversial plans, he was allowed back on duty and maintain the organisations £59 million budget.

The NHS Counter Fraud Service has also helped the NHS to fraud proof its systems leading to much lower rates of fraud than occurred in the past.