WHAT IS FRAUD?

Fraud is a broad term that refers to a variety of offences involving dishonest behaviour. Put simply fraud is the intentional deception of a person or entity by another made for monetary or personal gain.

The Fraud Act 2006 gives a statutory definition of the criminal offence of fraud, defining it in three classes—fraud by false representation, fraud by failing to disclose information, and fraud by abuse of position.

 

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FRAUD. RECOGNISE IT. REPORT IT.

EXAMPLES OF FRAUD

The size and diversity of the HSC means that fraud can take many forms. Generally speaking the perpetrators can be classified into four broad groups:

PATIENT

PATIENT

Patient fraud can include:

  • claiming for free or reduced cost dental and ophthalmic treatment when not entitled.
  • fraudulently attempting to obtain prescription medication.
  • individuals providing false information in order to access treatment or services they should pay for.

CONTRACTOR

CONTRACTOR

Contractor fraud can include:

  • claiming for treatment not provided.
  • charging for items of a higher cost than those supplied.
  • charging patients privately while also claiming reimbursement under health service regulations.

STAFF

STAFF

Staff fraud can include:

  • submitting false claims for hours worked.
  • submitting false claims for travel or expenses.
  • falsifying qualifications to obtain employment.
  • undertaking private work during paid HSC hours.

SUPPLIER

SUPPLIER

Supplier fraud can include:

  • submitting false invoices for goods or services not supplied.
  • offering a personal incentive to secure a contract.
  • price fixing.

FINANCIAL ABUSE

Counter Fraud Services are one of the stakeholders in the Northern Ireland Adult Safeguarding Partnership, providing investigative assistance to HSC clients where there is a suspicion that a HSC employee or a contractor has improperly or illegally used the assets or property of an adult with whom the HSC has a duty of care. 

 

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NATIONAL FRAUD INITIATIVE

The National Fraud Initiative (NFI) is an exercise that matches electronic data within and between public and private sector bodies to prevent and detect fraud.

Data matching involves comparing sets of data, such as payroll or benefit records of a body, against other records held by the same or another body. This allows potentially fraudulent claims and payments to be identified. Where a match is found it indicates that there may be an inconsistency that requires further investigation. 

 

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