Three strategic teams work together to deliver a comprehensive counter fraud service to Health and Social Care (HSC) in Northern Ireland. As well as investigating fraud it is our role to help prevent fraud from occurring in the first instance and to detect fraud where it may have occurred.
A key task of the Fraud Prevention team is to develop an anti-fraud culture across Health and Social Care. The team deliver presentations and awareness sessions to a wide variety of staff groups so we can ensure that HSC staff understand not just our role, but their role in helping tackle fraud against the health service.
The team also work closely with the Department of Health and HSC clients to develop policies and procedures to help prevent fraudulent activity within Health and Social Care and have responsibility for the management and administration of the regional fraud reporting system.
Our specialist Fraud Detection team use a wide range of analytical, data mining and investigative techniques in combination with a range of IT systems in order to detect fraud within or against the HSC.
The team deploy these techniques in a range of screening measures including patient entitlement to access free services, invoice discrepancies and supplier monitoring. In addition the team also provide support to the Investigation team in gathering the necessary evidence, analysing and presenting evidence for Court.
The team also review, make recommendations and provide advise to HSC clients on counter fraud measures that can be introduced to address system and/or contract weaknesses.
The Fraud Investigation team is staffed by fully qualified, professionally accredited counter fraud specialists. With a remit of countering fraud across Health and Social Care in Northern Ireland, this work extends across all HSC organisations and beyond where persons are receiving services provided or secured by a HSC body.
Our role is to investigate fraud against Health and Social Care, and we are authorised in law to employ a wide range of investigative tools and techniques in order to obtain the necessary evidence to progress each case.
HSC organisations have a responsibility to report cases of suspected fraud to CFS and we work in partnership with our clients, gathering evidence which will help the organisations to determine which appropriate sanctions should be applied in each case; disciplinary, criminal, civil or combination of all three. We also make recommendations and advise on counter fraud measures that can be introduced to address system and/or contract weaknesses.
Where evidence of fraud-related offences is found, we advise the client on the integrity and standard of evidence required and the likelihood of successfully pursuing a criminal prosecution.
We also actively engage with the PSNI and Public Prosecution Service, gathering, analysing and presenting evidence for Court and providing witness testimony in Court as required.