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.
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 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.
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.
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.