Maggie Worsfold is Patient Fraud
& Communications Manager, NHS Scotland Counter Fraud Services, UK. Email: mworsfold@nhs.net
Eurohealth INTERNATIONAL
COMBATING HEALTH CARE FRAUD IN
SCOTLAND
By: Maggie Worsfold
Summary: NHS Scotland has developed a clear strategy to combat health care fraud through its dedicated Counter Fraud Services (CFS) agency. Based on the '40s', the counter-fraud strategy centres on deterring, detecting, disabling and dealing with fraud. It also incorporates a strong role for communications to raise awareness of fraud across the National Health Service and to actively seek publicity as a means of deterrence. Since its inception, CFS has generated gross savings of £42.3 million.
Key words: Counter Fraud Strategy, Fraud Prevention, NHS Scotland Counter Fraud Services (CFS)
NHS Scotland Counter Fraud Services (CFS) provides a specialist service to NHS Scotland and is solely focused on counter fraud activities. While it is difficult to determine how much fraud exists, a report in 1994 by the Audit Commission and subsequent updates in 1996, 1998 and 199911 resulted in the Fraud Investigation Unit (FIU) being established to investigate fraud in the health service in Scotlandl'l.
With Scotland's health budget currently at £11 billion, even 1% of this being lost to fraud detracts from the funding which should be spent on patient care.
The original remit of the FIU was to investigate fraud in the Family Health Services by primary care contractors and patients. Gross savings generated in the period 2000 - 2004 equated to
£8.6 million. In 2004, Scottish Ministers extended the remit of the FIU and changed its name to CFS to reflect its new role which would include proactive investigations and deterrence as well as reactive investigations and patient exemption fraudE. The new remit
broadened the scope of CF S's activities to encompass secondary as well as primary care and to use intelligence and statistical analysis to identify areas of fraud risk.
The extended remit also incorporated a communications role to raise awareness of fraud across the NHS and to actively seek publicity as a means of deterrence.
Strategy against fraud
Since that time, the Scottish Government has developed a clear strategy to combat health care fraud where the core elements include:
• changing perceptions and attitudes to fraud to make it unacceptable and motivate ethical conduct;
• deterrence to stop fraud from happening in the first place;
• prevention by implementing strong internal controls to counter fraud;
• incorporating fraud proofing within policy design as far as possible;
Eurohealth incorporating Euro Observer -Vol.17 I No.4 I 2011
