FRAUD - Humber NHS Foundation Trust
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FRAUD
ISSUE 5– FEBRUARY 2019
Insight
AUDITONE SECURES MONEY RECOVERY FOLLOWING FRAUD CONVICTION
We previously reported the case of an agency nurse who systematically defrauded an NHS Trust of over £52,000
pleading guilty to one charge of fraud by false representation following an investigation carried out by
AuditOne investigators. The nurse who was employed via an agency worked full time for the hospital
for over 14 months and was required to submit a weekly timesheet detailing the hours she had worked. However
four months in to her employment the Nurse altered her weekly timesheet after it was authorised, claiming for hours
she had not worked. Over the proceeding eight months, the Nurse routinely falsified timesheets and authorising
signatures, claiming a total of 113 shifts that she had not worked. Following a full criminal investigation the
Nurse was interviewed under caution there she fully admitted the fraudulent claims she had made. She was
subsequently charged with the criminal offence of fraud by false representation and appeared at
Durham Crown Court where she was sentenced to 12 months imprisonment. The Nurse was also
struck off by the Nursing and Midwifery Council. Since her conviction AuditOne has taken
steps to recover the money lost as a result of the fraud. AuditOne pursued recovery of the
money from the agency that supplied the Nurse to the Trust and after eighteen
months of perseverance has now managed to secure a full refund of the
money that was lost. The recovery of over £50k will be
returned to the Trust and will now be used for its
proper purpose, patient care.
PUBLICITY: BBC DOCUMENTARY
NHS counter fraud professionals will take centre stage in a new
TV documentary called ‘Fraud Squad NHS’ which is to be shown
on BBC One. The programme follows the work of NHS
investigators as they track down the fraudsters who target the
NHS. The five-part series will air every day from Monday 4
February to Friday 8 February at 9:15am. Each episode will then
be available for one month on the BBC iPlayer. The
documentary will feature a selection of recent, successful
prosecutions of NHS fraud. The NHSCFA’s Forensic Computing
Unit also makes an appearance, as well as our partners in
counter fraud such as the police.
ALERT: “WHATSAPP” GOLD HOAX MAKES A COMEBACK
The 'WhatsApp Gold’ scam, which has being doing the rounds since 2016, has
surfaced again in the form of a new message.
In the message, it is claimed that there is a video which will be launched called
‘Martinelli’. The video itself is a hoax and does not seem to exist. The message also
warns of links being sent out to sign up for 'WhatsApp Gold'. Previous versions of
'WhatsApp Gold’ messages have included promises of free flights and ‘exclusive’
access to enhanced features such as the ability to make video chats, send 100 imag-
es at once and delete messages hours after they have been sent. Victims are urged
to sign up via a download link. After clicking on the link they are redirected to a fake
page and their phone will become infected with malware. Any updates to
WhatsApp will usually happen automatically through the app. If you receive a re-
quest to download 'WhatsApp Gold' do not click the link.
Mobile malware protection advice
• Always install the latest software and app updates.
• Don’t jailbreak or root your devices. Disabling software restrictions leaves your phone, as well as the private
data stored on it, vulnerable to malware and cyber criminals.
• Only install apps from official app stores, such as Google Play or the app store that came pre-installed with
your device.
NATIONAL: NHS MANAGER CAUGHT SHOW JUMPING WHILST OFF SICK WITH A BAD BACK
A senior NHS manager has been found guilty of defrauding her employers after being caught competing in horse
riding competitions while on sick leave. Elise David, 33, took four months off from her job as a quality manager at
the Surgical Materials Testing Laboratory at the Princess of Wales Hospital in Bridgend. She claimed to be
suffering from a back injury after falling from her horse on June 5, 2016, but during the course of her absence
from work she took part in a number of show jumping, dressage and cross-country competitions. Her offending
came to light after her employers saw results in her name on the British Eventing website and came into
possession of photographs which showed her riding a horse at some of the events. David denied one count of
fraud but was found guilty by a jury following a three-day trial at Newport Crown Court. In total, David received
£8,216 fraudulently between July 1, 2016, and October 11, 2016, with the beginning of her sick leave deemed
genuine. During her trial, David claimed that horse-riding was part of her recovery from the back injury. But she
told employers she was barely able to walk and that she was unable to drive while she was competing. Sentencing
directly after the guilty verdict was returned, Judge
Daniel Williams described the defendant as “cynical”
and “dishonest”. He said “you claimed to have been
too unfit to return to work for a period of four
months, but you were taking part in show jumping
tournaments. That I’m afraid says it all. You had to
attend a number of sickness reviews at the hospital.
They were unaware you had been show jumping
whilst on sick and your performance at those meetings
was comical. You appeared to be unable to walk
unaided. That sorry figure was a contrast to the
photos I have seen of you towering on your horse
whilst competing. Your actions were cynical and
deliberate and dishonest, and you felt entitled to
defraud the public purse. David was sentenced to 12
weeks imprisonment suspended for 12 months and
was ordered to carry out 180 hours unpaid work. She
was also ordered to repay over £8k she had
fraudulently obtained.
ALERT: STUDENT TAX SCAM
Thousands of fraud reports have been received by the tax au-
thority from students at university and colleges across the UK.
Fake emails, which use university addresses in a bid to appear
legitimate, may tell people that they are owed money and
encourage them to send their personal details. The recipient’s
name and email address may be included several times within
the email itself and the email will include links that redirect the
recipient to websites where their data is stolen. The emails often
spoof the branding of HMRC, Gov.UK or credit card branding.
Director of Action Fraud, Pauline Smith said: ‘Devious fraudsters
will try every trick in the book to convince victims to hand over
their personal information, often with devastating
consequences. It is vital that students spot the signs of
fraudulent emails to avoid falling victim by following HMRC’s
advice.”
NATIONAL CASE: DENTIST CONVICTED OF NHS FRAUD
Swansea dentist Elizabeth Anne White was sentenced to 12 months' imprisonment suspended for 12 months, for
fraud against the NHS (24 September 2018, Swansea Crown Court). She pleaded guilty earlier at the same court,
following an investigation by the NHS Counter Fraud Service Wales. White (paid back the entire amount before
sentencing and also voluntarily paid the NHS a further sum of over £10,000 to cover other
erroneous claims she had made. The dentist defrauded Abertawe Bro Morgannwg University
Health Board of at least £24,000 when she was the co-owner of Morgan and White Dental
Practice in Llangyfelach, Swansea, where she practised as a dentist. The investigation
uncovered that she had submitted multiple false claims for payment to the NHS Business
Services Authority, deliberately inflating the Units of Dental Activity (UDAs) she had actually
delivered to make more money from the NHS. White was in the habit of making multiple
claims to the NHS for what were really single courses of treatment to maximise her income.
For example, she would submit a separate claim for an examination and then additional
claims for fillings, crowns or dentures. Investigators spotted notes on records which were
reminders to enter false treatment dates on the related claim forms. As well as this illegal
"treatment splitting" of single NHS treatments into two or more courses, the dentist also made bogus claims for
work that was never done at all. White made 398 false claims for UDAs for dental examinations and treatments
between 2006 and 2014, including 315 instances of multiple claims by "treatment splitting" and 83 bogus claims
for examinations or treatment which was not provided. NHS CFS Wales’ lead investigator on the case, Mark
Weston, said: "Fraud against the NHS is totally unacceptable, removing money from the system which is intended
for patients. Elizabeth White seems to have been driven by greed. As a dentist she was in a privileged position of
trust, which she has abused. NHS CFS Wales will take all appropriate action in each case we investigate, including
pursuing criminal charges where necessary. The Abertawe Bro Morgannwg University Health Board can now spend
the recovered £34,395.09 on delivering NHS services."
PRESENTATIONS: CAN YOU HELP ?
As your fraud provider we are always looking at ways to raise awareness of fraud within your
organisation. One of the key ways we do this is by delivering counter fraud presentations. Our
interactive presentation focuses on real life fraud cases with mainly news clippings and the
stories behind them. The presentation can be tailored to suit the audience and time available.
So if you have a monthly/quarterly team meeting and fancy hearing from a team you might
not ordinarily consider, why not give us a go. Contact details for the team can be found on the
last page of this newsletter or by searching fraud on your organisations intranet.
THE SPOTLIGHT
The spotlight section of the newsletter focusses on fraud and corruption
types that commonly occur in the NHS. It provides you with details of
how the offences are committed and real life examples of where people
have been prosecuted for these offences. This addition looks at:
BRIBERY
CASE STUDY 1:
An NHS director who was responsible for
procuring new software for the hospital
THE ISSUE: (value £950k) met with a supplier for lunch.
During this meeting the director said he could
Bribery can take various forms and can include gifts, hospitality,
see how the proposal was of value to the
personal benefits and cash. We all need to be mindful of the
Trust but he couldn't quite see how it would
intentions of external parties when they offer us anything,
benefit him. The director was
especially when we’re in the process of awarding contracts or
soliciting a bribe from the supplier. The
making important business decisions.
director subsequently agreed to award the
HOW ARE THESE OFFENCES COMMITTED: contract to the supplier but as part of that
There are two general offences of bribery within the Bribery Act: deal agreed he would receive personal bribe
payments from the company. The director
• Offering or giving a bribe to induce someone to behave, or
was paid over £80k by the
to reward someone for behaving improperly; and
supplier. Following an investigation the director was sentenced to
• Requesting or accepting a bribe either in exchange for three and a half years imprisonment and the supplier sentenced to
acting improperly, or where the request or acceptance is fourteen months imprisonment. Sentencing, Judge Stephen Climie
itself improper said: "Those charged with the financial management of the system
are holding the very purse strings that can ultimately prevent pain
For example an NHS employee working on a tender process for
and suffering or even death of patients”. The corruption led to the
patient travel services accepts tickets to a concert from one of
directors wife, resigning as the trust's chief operating officer and
the companies tendering for the contract in order to sway the
deputy chief executive. There was no suggestion she was involved.
tender process in their favour. The NHS employee commits an
offence by accepting the tickets and the company employee CASE STUDY 2:
commits an offence for giving them.
A court clerk was the first person to be jailed under the Bribery Act
YOU SHOULD: when he was sentenced to six years imprisonment. Munir Patel,
worked as a clerk at Redbridge Magistrates Court. As part of his role
• Never seek personal gain at your organisations or anyone he had access to the courts computer systems. Patel
else’s expense. approached people facing motoring prosecutions, offering to wipe
• Always protect your organisations assets including the court records for £500 payments. Patel’s offending was
financial, information, goodwill, property and reputation unearthed when the Sun newspaper became aware and ran an
undercover sting operation. Judge Alistair McCreath said: "A justice
• Not offer or provide bribes or kickbacks to win
system in which officials are prepared to take bribes in order to
business or to influence a business decision
anywhere on anything. allow offenders to
escape the proper
• Never accept, offer or solicit a facilitation payment consequences of their
• Always comply with national and international laws and offending is inherently
regulations corrupt."
• Be alert to the possibility that others might be attempting
to deceive
• Always report your concerns of fraud and bribery
A FEW QUICK QUESTIONS WITH...
Counter Fraud Manager Rebecca Napper
What did you do before you became a counter fraud
manager?
I’ve worked in the NHS for over 22 years and started off in GP fundholding,
then moved into primary care where I did everything from managing waiting
list activity and rolling out translation services to implementing the new GP
contract. The experience gave me a great knowledge base when I moved
into the fraud arena.
What does a normal week look like for you?
I can’t recall one week that has ended how I envisaged it would!
Although I have planned diary commitments, there will always be
something that crops up that needs to be responded to or resolved.
That’s part of the appeal of the job for me; very rarely are two days
the same and I enjoy having to problem solve.
What parts of your job do you find most challenging?
Having moved up to the region from south west London
What advice would you give to someone who wants to work
18 months ago, a big challenge for me is geography. I
within counter fraud?
don’t have the geographical knowledge that my
colleagues have so I rely on them to help me. Another I would suggest some research to fully understand the role – its
challenge is keeping up with national and local fairly unique in that we don’t just undertake criminal investiga-
developments; the NHS is constantly going through tions but try to stop fraud from happening and actively
change, which will always bring a potential risk of fraud promote our work to publicise the potential impact and out-
so I’m mindful that we need to be aware of comes to deter people from committing fraud. It’s a wide-
developments. ranging role which requires a lot of different skills, so being
adaptable and inquisitive is a must.
What do you enjoy most about being a counter fraud
manager? What’s your favourite quote and why?
I’m passionate about the NHS and strongly feel that it ‘Every day is a learning day’ – not especially profound but
should be protected to ensure that everyone is able to accurate for me.
receive the care they need. I enjoy being able to make
Contact details for Rebecca:
recommendations to ensure a fraud risk is minimised;
this may be a small change that protects a small part of T: 0191 441 5941
the NHS but if it’s replicated across the wider NHS it E: rebecca.napper@audit-one.co.uk
could have a significant impact on minimising losses to
fraud.
13,357 #cyber crime reports were made to
ActionFraud between April and September
2018
Cyber crime victims lost £34.6m between
Apr to Sept 2018.
Nearly 1.5 million new phishing websites are
created each month. Always #TakeFive if
you receive an unsolicited request for your
personal or financial details. #CyberProtect
MEET THE COUNTER FRAUD TEAM
Terry Smith Rebecca Napper Michelle Watson Paul Bevan
Head of Service Counter Fraud Manager Counter Fraud Manager Counter Fraud Specialist
T: 0191 441 5939 T: 0191 441 5941 T: 0191 333 3074 T: 0191 441 5918
E: terry.smith@audit-one.co.uk E: rebecca.napper@audit-one.co.uk E: michelle.watson@audit-one.co.uk E: paul.bevan@audit-one.co.uk
Gemma Collin Martyn Tait Iain Flinn Nikki Cooper
Counter Fraud Support Counter Fraud Specialist Counter Fraud Specialist Counter Fraud Specialist
T: 0191 333 3011 T: 0191 333 6218 T: 0191 441 5935 T: 01482 866 800
E: gemma.collin@audit-one.co.uk E: martyn.tait@audit-one.co.uk E: iain.flinn@audit-one.co.uk E: nikki.cooper@audit-one.co.uk
Stephen Veitch Kathryn Wilson Simon Clarkson Gary Ross
Counter Fraud Specialist Counter Fraud Specialist Counter Fraud Specialist Security Management Specialist
T: 0191 333 3012 T: 0191 441 5933 T: 01228 635 597 T: 0191 333 3011
E: stephen.veitch@audit-one.co.uk E: kathryn.wilson@audit-one.co.uk E: simon.clarkson@audit-one.co.uk E: gary.ross@audit-one.co.uk
FRAUD HOTLINE 0191 441 5936
NATIONAL HOTLINE 0800 028 4060
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