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FOR THE HEALTH AND SOCIAL CARE SECTOR COUNTER FRAUD
NEWSLETTER
Contents
AI in Recruitment – Fraud Risks and Mitigations
Prescription Fraud Sentence
NHS Worker Convicted of Fraud
NHS Nurse Sentenced For Theft
Parking Fine Text Scam
Reporting Fraud
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Introduction
The Strategic Pillars The NHSCFA 2023-2026 Strategy:
Welcome to our Winter Counter Fraud Newsletter. The NHS Counter Fraud Authority (NHSCFA) continues to estimate that the NHS is vulnerable to £1,264 billion worth of fraud each year. Fraud is deception carried out for personal gain, usually for money. Fraud can also involve the abuse of a position of trust. By ‘NHS fraud’ we mean any fraud where the NHS is the victim. While those who commit fraud against the NHS are a small minority, their actions have a serious impact on us all. Fraud against the NHS could be committed by anyone. This includes members of staff, patients, contractors, suppliers, medical professionals and external parties, such as cybercriminals.
Working together to understand, find and prevent fraud, bribery and corruption in the NHS’ focuses on four key pillars: Understand, Prevent, Respond and Assure.
1. Understand how fraud, bribery and corruption affects the NHS.
Fraud takes taxpayers’ money away from patient care and into the hands of criminals. Everyone has a part to play in fighting fraud and being aware of the risk and remaining vigilant are the most important first steps, followed by knowing how to report fraud. Contact details for reporting fraud in confidence are included at the end of this newsletter so if you have any suspicions that fraudulent activity may be occurring, please report this at the earliest opportunity.
2.
We will ensure the NHS is equipped to take proactive action to prevent future losses from occurring.
3.
When we know that fraud has occurred, we are equipped to respond .
We can assure our key partners, stakeholders and the public that the overall response to fraud across the NHS is robust.
4.
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AI in Recruitment – Fraud Risks and Mitigations
As artificial intelligence (AI) continues to revolutionise various industries, its impact on recruitment processes has become increasingly significant. While AI offers numerous benefits, it also presents new challenges in detecting and preventing fraud. This article explores the emerging risks associated with AI in recruitment and provides guidance on mitigating these threats.
Understanding AI-Enabled Recruitment Fraud AI-enabled recruitment fraud can take various forms, including AI- generated job applications that may be generic, impersonal, or contain false information. Deepfake videos could also be used to impersonate authority figures during interviews, or AI could be used to provide responses to interview questions during online interviews. Red Flags to Watch For When reviewing applications and conducting online interviews, be alert for these potential indicators of AI-assisted fraud. These include, but are not limited to:
• Inconsistent language or writing style throughout the application.
• Overly complex sentences with unusual vocabulary or phrasing.
• Incomplete answers or unexplained gaps in employment history.
•
Similarities between multiple applications.
•
Stilted or robotic responses during interviews.
• Candidates appearing distracted or pausing frequently before answering questions.
• Candidates refusing to turn their camera on or consistently muting themselves between questions.
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The Risks of Recruitment Fraud Recruitment fraud poses significant risks to healthcare organisations and the NHS as a whole. The potential consequences are far-reaching and include:
Mitigating AI-Related Recruitment Risks To protect your organisation from AI-enabled recruitment fraud, consider implementing these strategies:
• Update policies and procedures to address AI use in recruitment processes.
• Hiring unqualified candidates can put patients at risk of harm, which is of paramount concern.
• Require candidates to disclose any AI assistance used in their applications or interviews.
• Organisational security may be compromised in the event that successful candidates are not who they purport to be, some of whom may have ulterior motives.
• Utilise AI detection software to identify potentially AI-generated content.
• Staff involved in fraudulent activities may face severe sanctions, including loss of job and career.
• Design application forms with role-specific questions to assess genuine understanding.
• The NHS can suffer financial losses, potentially impacting its ability to provide services.
• Conduct in-person identity checks on the first day of employment, or prior to this where possible, comparing the identity of the person in front of you to the person interviewed.
• Adverse media attention can damage the reputation of the organisation, leading to a lack of trust in NHS and other health and care services.
• Cross-reference applications to identify similarities indicative of bulk submissions.
• Non-compliance with regulations may result in sanctions, and negative outcomes within Care Quality Commission inspections.
• Maintain strict adherence to NHS Employers’ Pre-employment Check Standards.
Additionally, there’s a risk of inadvertently excluding potential candidates from the talent pool if policies around AI use are too restrictive. These multifaceted risks underscore the importance of maintaining vigilant recruitment practices and fraud prevention measures.
While it’s crucial to address the risks associated with AI in recruitment, it’s equally important not to inadvertently exclude qualified candidates. Strive for a balanced approach that leverages AI’s benefits, while maintaining robust fraud prevention measures.
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Case Study 01
Former NHS Employee Sentenced for Prescription Scam
A recent case of fraud within the NHS has come to light, highlighting the importance
of vigilance in the healthcare sector. A former employee of Somerset NHS Foundation Trust has been convicted of fraud after abusing their position to obtain prescription drugs illegally.
T he individual in question appeared before Taunton Magistrates Court on 20 June, where they pleaded guilty to fraud by abuse of position, as defined in sections 1 and 4 of the Fraud Act 2006. The court handed down a sentence of 100 hours of community service and ordered them to pay £142.94 in compensation, plus a victim surcharge. The case came to the attention of authorities thanks to the sharp eye of a pharmacist in the South West. When the subject presented a suspicious prescription, the pharmacist’s instincts led them to question its authenticity. The subject claimed the prescription was for a parent with a chronic condition, but further investigation revealed this to be false.
Investigation and Findings The trust’s counter fraud team conducted a thorough investigation, uncovering that the individual had successfully obtained drugs from nearly a dozen pharmacies across the South West earlier in 2023. This pattern of behaviour demonstrated a significant breach of trust and a calculated approach to defrauding the NHS. The trust’s counter fraud manager, commended the pharmacist’s prompt action, stating, “If it hadn’t been for the prompt action of the pharmacist, then this fraud was likely to have continued, unchallenged. While the financial value of the drugs this individual obtained was low, the fraud the individual took part in demonstrated a high degree of dishonesty and a significant abuse of trust that his job role gave him. This conviction sends out a strong message that we will take action whenever individuals seek to criminally abuse their position of trust as a healthcare worker.”
Implications and Message This case serves as a stark reminder of the potential for abuse within the healthcare system. The trust has emphasised that such actions not only constitute a criminal offence but also betray the core values of the NHS. The conviction sends a clear message that the NHS will not tolerate any form of fraud or misconduct by its employees. The incident underscores the crucial role that all healthcare professionals play in maintaining the integrity of the NHS. It also highlights the effectiveness of existing safeguards, such as the vigilance of community pharmacists, in detecting and preventing fraud. As the NHS continues to face financial pressures, cases like this emphasise the need for robust systems to prevent misuse of resources and maintain public trust in the healthcare system.
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Case Study 02
NHS Worker Sentenced for £5,250 Fraud in Swansea
A former healthcare support worker has been convicted of defrauding the NHS, receiving a sentence that includes community service and full repayment of the fraudulently obtained funds.
A former Health Care Support They had earlier admitted to fraud by false representation, an offence under Section 2 of the Fraud Act 2006. The court imposed a 12-month High-Level Community Order, requiring the individual to complete 140 hours of unpaid work. Additionally, they must repay £5,250 to SBUHB, covering the full amount of the fraud, in addition to £500 in investigation costs and £95 in Crown Prosecution Service (CPS) fees. Worker, who previously worked for the Swansea Bay University Health Board (SBUHB), appeared before the court in September 2024.
The fraud occurred during a period of almost seven months between 18 August 2021 and 12 March 2022, when the individual was on sick leave from SBUHB. During this time, they allegedly worked as a community care worker for another organisation, effectively double- dipping and misusing NHS resources. The case faced some delays, with the individual initially failing to attend their court hearing, resulting in an arrest warrant. They were eventually apprehended by South Wales Police, and appeared before Swansea Magistrates Court, leading to a guilty plea being made.
This successful prosecution is a testament to the diligence of the Local Counter Fraud Specialist and their team. Their efforts underscore the NHS’s commitment to combating fraud and protecting public funds. The case serves as a reminder of the serious consequences of defrauding the NHS and the importance of maintaining trust within the healthcare sector. It also demonstrates the effectiveness of the legal system in addressing such misconduct and ensuring accountability.
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Case Study 03
Former NHS Nurse Sentenced for £24.8k Theft in Llanelli
A former NHS nurse has received a suspended jail sentence after admitting to defrauding the NHS out of nearly £25,000. The case, heard at Llanelli Magistrates Court, demonstrates the serious consequences of misappropriating public healthcare funds.
T he individual appeared before the court on in September 2024, where they pleaded guilty to theft. The court handed down a sentence of 26 weeks’ imprisonment, suspended for 12 months. The individual was also ordered to complete 150 hours of unpaid community work and attend 15 days of rehabilitation services. Furthermore, they must pay a £154 victim surcharge and £80 in additional costs.
The theft occurred during the individual’s employment as a Clinical Site Manager at the Princess of Wales Hospital in Bridgend, under Cwm Taf Morgannwg University Health Board (CTM UHB). Although they left their position in August 2022, they continued to receive a salary until the end of June 2023, with salary payments totalling just over £24,800. Investigations revealed no evidence that the individual had attempted to inform CTM UHB about the ongoing salary payments and they instead spent the money, effectively diverting resources meant for NHS services.
The theft came to light during an audit, leading to an interview under caution being held where they admitted to knowingly receiving and spending the unentitled payments. This case supports the NHS’s commitment to financial integrity and the consequences of fraudulent activities within the healthcare system.
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Parking Fine Text Scam Hits Suffolk Residents
Residents are urged to remain vigilant and to verify any parking fine claims through official channels before taking any action.
T he BBC has reported that Suffolk councils have issued an urgent warning about a widespread text message scam targeting local residents with fake parking fines. The fraudulent messages, part of a national scam operation, are causing concern among communities across the county and have already hit counties outside of Suffolk. West Suffolk Council has taken the lead in alerting the public about these deceptive texts. The messages contain a link to a counterfeit government website, where unsuspecting individuals are prompted to enter their vehicle registration number. Subsequently, the site falsely claims that a £20 parking fine is due.
A local resident who doesn’t drive shared their experience of receiving one of these scam texts, stating the text demanded £60 and threatened an increase if not paid promptly. The individual dismissed the message they do not drive; however other residents in the area had reported similar messages on local social media platforms. West Suffolk Council emphasised that it never issues parking fines via text message and advised that if one of these texts is received, the link should not be opened and the fine should not be paid. Recipients are encouraged to report the scam by forwarding the text to 7726, as recommended by Action Fraud and the National Cyber Security Centre.
The council clarified that legitimate fines are always issued as yellow penalty charge notices placed on vehicle windscreens by authorised civil enforcement officers. Suffolk Trading Standards confirmed that these fake texts are part of a nationwide scam. While they have received multiple reports about the messages, no cases of actual payments have been reported thus far.
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Reporting Fraud
Everyone has a part to play in fighting fraud. If you work for the NHS and suspect any fraud, bribery, or corruption against the NHS, please contact your Local Counter Fraud Specialist. Alternatively, please contact the NHSCFA 24-hour reporting line by calling 0800 028 4060 , or by completing the online reporting form. All reports are treated in confidence, and you have the option to remain anonymous.
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