While the vast majority of people who work for, supply, or use the services provided by Health and Social Care (HSC) in Northern Ireland are honest there are a small minority of individuals who attempt to defraud our health service. These offenders vary - from patients falsely claiming help with health costs, to staff gaining employment using false documentation, or contractors and suppliers falsifying records or invoices to claim more money than they are owed.
Fraud can take many forms but ultimately any resources lost to fraud means there is less money available for the delivery of front line services. This is money that could be directly available for patient care.
Fraud prevention and the early detection of fraud is always preferable to an investigation after the event – but would you recognise fraud?
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.
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 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 fraud can include:
- submitting false invoices for goods or services not supplied.
- offering a personal incentive to secure a contract.
- price fixing.
We have produced a range of information sheets aimed at providing a better understanding of fraud, why people commit fraud and the impact it can have on health service resources.
We have developed a series of counter fraud factsheets focusing on four common examples of staff fraud. Each factsheet provides a case example of the topic covered and general advice on how to prevent the type of fraud.
Anyone can report a suspicion of fraud against Health and Social Care (HSC) in Northern Ireland. If you are a member of staff employed within the HSC you should raise the matter with your supervisor, line manager or other senior staff within your organisation, such as your local Fraud Liaison Officer or Director of Finance. Every HSC organisation has a Fraud Policy and Response Plan which provides further and guidance.
If you do not work within the HSC or would prefer to report your concern in confidence you can call the HSC Fraud Hotline on 0800 096 33 96 or use our online reporting form.