Fighting fraud in our health service one case at a time
SAM VOLPE speaks to the team who are on the case when it comes to NHS fraud
FRAUD costs the NHS more than £1bn each year – but in the North East, a firm of retired police officers and counterfraud experts work to root out crime in our health service, and to help healthcare staff spot when something untoward may be occurring.
Michelle Watson and Paul Bevan both work for Audit One – the Durham-based non-profit firm tasked with preventing fraud in the first place, and also with finding those responsible when the worst happens.
Whether it’s an NHS accountant siphoning off cash or a nurse moonlighting in care homes when they are supposed to be on sick leave, Audit One will investigate and do their best to ensure money doesn’t go missing.
Michelle Watson, the firm’s head of operations, is an ex-police officer who has now spent decades in counter-fraud, while Paul Bevan is a member of the proactive team working to educate members of the health service about where fraud could happen.
Michelle explained: “We have a proactive team and a reactive team. The reactive team is the one which does investigations into issues that may be flagged up, while the proactive team is about what we do to prevent fraud.
“Pretty much all of us have backgrounds investigating fraud in other public sector organisations – including our investigation team staffed by three retired police officers.”
Paul, who lives in Sunderland, works on the proactive team, and explained much of his job involved looking for risks and ensuring people in the NHS knew how to mitigate them.
“We look at how we can prevent fraud and the most important route is through education,” he said.
“We look to raise awareness of potential frauds and try to get to the message out to the public, and to patients and staff in the NHS – because it costs the NHS a lot of money.
“We go down to look at fraud risks within an organisation and look to lower those risks or eliminate them if at all possible. Out of that, if the suspicion of fraud arises, we then refer to our investigation team.”
Major frauds include “working while sick”, which is simply when a member of staff claims to be on sick leave but is in reality working other jobs, while Paul also warned of “mandate fraud” – when “which is where someone within an organisation – potentially an NHS supplier – tries to change the details on a payment to divert the money”.
Michelle added: “This year we have been notified about five or six times by our clients that someone has tried to get them to change a supplier’s bank account details. It’s still a big risk, but we feel our clients are well-aware of it now.”
Paul said changes in organisations caused risk, and with the NHS undergoing a radical reorganisation, this was something Audit One were playing close attention to.
“There are always new risks emerging,” he said. “The NHS is going through massive organisational change. We have 123 risks on our risk register – one of those it that organisational change always creates opportunities for people to commit fraud. That transformation will mean a transfer of staff from one body to another, that may give people opportunities.”
He said other high risk areas included procurement for public sector contracts, and added: “Obviously Covid procurement is a significant area we will be likely have a proper look-back process nationally.”
During the early stages of the pandemic, with normal work at a halt, Paul spent time helping to courier NHS samples between hospitals and labs, while other members of Audit One staff helped provide PPE to key workers and even fit face-masks to frontline medics.
Michelle spoke about the investigations the team undertakes. “I get to talk about the sexier kind of fraud,” she said. “The last thing people remember are the cases. Most people are astonished that people would steal money from the NHS.
“The kinds of fraud we deal with are usually committed by NHS staff, suppliers or patients – though it’s a tiny minority of NHS staff who do this. And when we do uncover a fraud in the NHS, the colleagues who work alongside the individual they feel devastated – that the person they worked with has not just stolen money but they have done it right beside them. The most common thing with NHS providers is staff working while on sick leave. With CCGs it is mostly about procurement strategy.”
Audit One has the power to carry out criminal investigations, though the team don’t have the power to arrest anyone. Michelle added: “We will also work with organisations to get them back money that has been defrauded. Every pound lost to the NHS is a pound lost to patients – so every pound is vital.
“One specific example we had in court recently was a health care assistant who was on sick leave from the NHS but getting paid and she had two other jobs.”
Other examples of Audit One’s work include the 2018 case of Gemma Dodds, a nurse who stole £50,000 from the County Durham and Darlington NHS Trust, and that of Peter Summerhill – a Teesside NHS IT boss who sold off NHS IPhones for personal profit.
Michelle, who lives in South Northumberland, added: “The majority of NHS staff are absolutely first class but we have to keep a grip and can never sit on our laurels.”
Pretty much all of us have backgrounds investigating fraud Michelle Watson