Contents. Introduction. How to report a fraud. What happens when you report a fraud? The investigation process

Transcription

1 1

2

3 Contents Introduction How to report a fraud What happens when you report a fraud? The investigation process Who decides if the case should go to court? What is a non-court disposal? What happens at court? Will I have to go to court? Attending court as a witness What if the NHS CFS decides not to prosecute? What punishments can the court hand out? Where can I find more information?

4

5 Introduction We all know that the majority of people who work in and use the NHS are honest, but a minority will seek to defraud it. It s important that we are all aware of the types of fraud that are committed and are not afraid to report fraudulent behaviour. Whether you are an NHS employee, contractor, supplier of goods and services or a member of the public, your input is crucial to help us tackle fraud and corruption in the health service. Anyone can report concerns about fraud in the NHS. This guide explains what is likely to happen when you report a suspicion of fraud to the NHS Counter Fraud Service (NHS CFS) or a Local Counter Fraud Specialist (LCFS) from how your report will be investigated through to what happens if you are asked to be a witness at court. It includes the possible outcomes and how you will be kept informed. Your NHS trust s LCFS may already have discussed these matters with you and can give you information and support. To find out more about how fraud in the NHS is being tackled, visit Information can be given to the confidential NHS Fraud and Corruption Fraud in the NHS 1

6 How to report a fraud Reporting Line freephone (lines are open 8am 6pm Monday to Friday). All calls are dealt with by trained staff and professionally investigated. Alternatively, you can report your concerns online at: You can also report any concerns you may have about fraud in your trust to your LCFS. 2 Fraud in the NHS

7 What happens when you report a fraud? When the NHS CFS receives a fraud referral, its specialist fraud investigators will first decide whether it can be investigated. If an investigation is possible, the case will be either allocated to the trust s LCFS or, in certain circumstances such as high-value frauds or those that cross health body boundaries, referred to a counter fraud specialist in the NHS CFS. Depending on what stage an investigation or court case is at, the person alleged to be responsible for an offence may be referred to in different ways: They will be called: the suspect during the investigation the defendant during the court case the offender if they are found guilty. When an investigation commences, a counter fraud specialist in the NHS CFS will set about collecting evidence such as witness statements and will interview the suspect. They may take advice from a lawyer at any stage of the investigation. Once the counter fraud specialist has completed their investigation, the following options are available: Take no action at all this can happen at any time in the investigation. Refer the matter to the trust for internal action. Offer the suspect a non-court disposal (e.g. a warning or a caution) see page 6 for more details. Charge the suspect at the police station or summons them in writing. Conduct a private prosecution. Use the police to assist with the prosecution. Fraud in the NHS 3

8 Investigation process Allegation investigated by LCFS or NHS CFS? yes no No further NHS CFS action Possibility of internal trust action NHS CFS or LCFS collects evidence (e.g. witness statements) and interviews suspect Evidence passed to lawyer for advice Suspect charged or summonsed? yes no Lawyer advises non-court disposal? yes no Case begins court process see What happens at court? section Non-court disposal actioned If appropriate, NHS CFS gives evidence to external regulatory body 4 Fraud in the NHS

9 Who decides if the case should go to court? Evidence is collated and passed to a lawyer for advice on whether the case is suitable to go to court. The lawyer must make such decisions in line with official guidance known as the Code for Crown Prosecutors. This states that before any case can be taken to court, the lawyer must be satisfied that, in their opinion: A: There is enough evidence that can be used to give a more than 50/50 chance of the suspect being convicted. If there is not enough evidence, the case cannot be taken to court, no matter how serious or important it is. Once the lawyer has decided that there is enough evidence, they must also be satisfied that: B: It is in the public interest to take the case to court. It should be noted that there are many other factors that must be taken into account when deciding if a prosecution is in the public interest. Fraud in the NHS 5

10 What is a non-court disposal? There are a number of ways in which a case can be officially dealt with without it going to court. These include the issue of a caution or conditional caution: Caution (also called a simple caution) A caution can only be given if the offender has admitted the offence and there is sufficient evidence to support a prosecution but it is felt appropriate to deal with the offence outside of the court process. A caution will appear on a person s police record. Conditional caution A conditional caution is similar to a simple caution but carries conditions that the offender must comply with. Failure to do so may result in prosecution for the original offence. A conditional caution can only be given if the offender has admitted the offence and there is sufficient evidence to support a prosecution but it is felt appropriate to deal with the offence outside of the court process. These are known as non-court disposals. Other types of non-court disposal include reprimands or final warnings (for juveniles) and warnings (for adults). These will not usually be used in fraud cases. The NHS CFS and lawyers have the final say in deciding how a suspect should be dealt with, and will take into account the views of the defrauded trust. This decision is always made in conjunction with the trust s Director of Finance. This is also the case if the decision is to offer a caution or conditional caution. For offences with no individual victim, arrangements should be made locally for the LCFS to take the role of official victim on behalf of the NHS body affected. 6 Fraud in the NHS

11 What happens at court? If the NHS CFS decides that action should be taken, court proceedings will begin. Most cases will appear in court several times before a trial takes place or a sentence is imposed. It can be several months after your report before the investigation is concluded. There are a number of different court hearings that might be required once the suspect has been charged or summonsed. These include: hearings to determine whether the case will be heard in a magistrates court or Crown Court (depends on how serious the offence is) hearings to decide whether someone who has been kept in custody since being arrested should remain there or be released on bail hearings where the defendant is formally asked to plead guilty or not guilty. If the defendant pleads guilty The court will arrange a sentencing hearing. This may not take place for several weeks as the court may need reports to help determine the appropriate sentence. These may include psychiatric reports, medical reports and reports on what type of non-prison sentence would be suitable. Fraud in the NHS 7

12 What happens at court? If the defendant pleads not guilty The case will go for trial. A date will be set, which may be several weeks or even months in the future. The prosecution and then the defence will present their evidence. This will include some or all of the witnesses giving their evidence at court. In a magistrates court, the panel of magistrates (or a single District Judge) will decide if the case has been proved and declare the defendant guilty or not guilty. In the Crown Court, the jury will decide. Where a defendant is found guilty, a sentencing hearing will normally be arranged, as detailed above. 8 Fraud in the NHS

13 Court process First court hearing is always in a magistrates court. There may be two or three preliminary hearings here to resolve various legal matters. Type of offence Summary Indictable All summary offence cases will stay in the magistrates court Defendant asked to plead Guilty Not guilty Date set for trial. Witnesses told if they must attend in person. Magistrates (or District Judge) decide if defendant is: Guilty Not guilty Indictable cases can be tried in a magistrates court or Crown Court Case to be heard in: Magistrates court Crown Court Defendant asked to plead Not guilty Guilty Date set for trial. Witnesses told if they must attend in person. Jury decide if defendant is: Not guilty Guilty Case may be adjourned for reports to be prepared for the court Case ends No further criminal action possible Case may be adjourned for reports to be prepared for the court Sentence imposed by the court and any orders to pay compensation or legal costs made. Fraud in the NHS 9

14 Will I have to go to court? This will not usually be clear until the defendant is asked to plead guilty or not guilty. If the defendant pleads guilty, the witnesses will not normally have to go to court. As most court hearings are held in public, you may wish to attend the sentencing hearing to find out what punishment the court decides on and why. If the defendant pleads not guilty, a trial will be arranged. If a trial does take place, all witnesses may be asked to attend court and give evidence. You will be notified in advance of the date of the trial and how long it is expected to last. If the case is expected to take more than a day, you may also be told on which day you should go. The counter fraud specialist will keep all witnesses informed. Trials in a magistrates court will usually be given a fixed date. If the trial is to take place in the Crown Court, the case may be put on the warned list, which means that the trial will begin some time within a two-week period. You may only be notified of the trial date the day before it is due to start. Once you are told that the case has to go to trial, you must contact either the Witness Support Service or the counter fraud specialist immediately if there is any reason why you may be unable to attend court. If you have access to the internet, you can watch a video produced by the government about what happens if you have to go to court: Or you can read or listen to the interactive guides at: 10 Fraud in the NHS

15 Attending court as a witness The thought of going to court to give evidence can be worrying. Victim Support operates a Witness Support Service offering support and information (see page 15 for contact details). They may be able to arrange a visit to the court before the trial to help you familiarise yourself with the building and the process. They will also be able to give you information on what you should do when you attend court for the trial (where to sit, who to ask for assistance, etc). When you arrive at court, you should be contacted by the counter fraud specialist, who will answer any questions you may have. They will usually escort you to the Witness Support Service waiting area. You should not normally have to wait in the same area as the defendant or their friends and family. Directly employed NHS staff will usually be given paid time off to attend court as a witness. If you are employed by a contractor, there may be different arrangements. Witnesses can be paid expenses for attending court and, in some cases, compensation if they have lost earnings because of this. Fraud in the NHS 11

16 What if the NHS CFS decides not to prosecute? Even if the decision is made not to prosecute, other action may be possible. For example, the health body may take internal action if the suspect is an employee or refer the case to an external regulatory body, such as the General Medical Council or Nursing and Midwifery Council, for consideration. 12 Fraud in the NHS

17 What punishments can the court hand out? For most offences, the courts have access to a range of different sentencing options. When deciding on the sentence to impose, judges and magistrates must bear in mind the principles of sentencing, which are: protecting the public punishing offenders reducing crime rehabilitating offenders offenders paying funds back into the NHS (this can be the NHS trust defrauded). They must also consider: how long the fraudulent activity lasted whether the offender was caught or confessed the defendant s character and record (i.e. if they have been convicted previously) the defendant s personal circumstances and whether they have shown remorse for their actions. All of the following sentences will be recorded on the Police National Computer, meaning that the offender will have a criminal record. Types of sentence Absolute and conditional discharge Even if an offender is found guilty (and now has a criminal record), the court may decide that it is not appropriate to impose a punishment. An absolute discharge means that the matter is closed. A conditional discharge means that there is no immediate punishment. However, if the person commits another offence within a specified period, they can be punished for the original offence as well as the new one. Fraud in the NHS 13

18 What punishments can the court hand out? Fine The maximum fine available in a magistrates court is 5,000. However, the court must consider the offender s finances before deciding on the level of the fine. A fine can normally be imposed in conjunction with most other types of sentence. Community sentence A community sentence is a court order that the offender is legally obliged to comply with. Failure to comply can mean being taken back to court, where a more severe order can be imposed. Failing to comply with this second order can lead to the court passing sentence for the original offence, with the full range of sentences available. Imprisonment The length of a prison sentence will depend on how serious the offence is, as well as other factors. Different offences carry differing maximum penalties. If the offender has been in custody before, the trial time will be deducted from the time they have been sentenced to. If this is longer than the time they are sentenced to, they will be released immediately. Suspended sentence In some cases, the court can impose a suspended sentence order. This means that the offender must abide by conditions set out in the order. If they fail to do so, they risk being sent to prison. Deferred sentence The court may not impose a sentence immediately, choosing instead to postpone the decision for up to six months. During this period, the offender s behaviour will be monitored by the probation service. The court may also impose conditions to regulate their behaviour during this time. The offender must agree to sentence being deferred. 14 Fraud in the NHS

19 Where can I find more information? Victim Support is an independent charitable organisation offering support and information to those affected by crime both victims and witnesses. The police will usually give you contact details for the local Victim Support unit and ask if you wish your own details to be passed to them. You do not have to agree to your details being given to Victim Support, nor do you have to approach them through the police. Victim Support can also help victims and other witnesses who have to attend court before, during and after the case. Tel: supportline@victimsupport.org.uk Website: You can also contact your trust s LCFS (details on next page). More useful websites Crown Prosecution Service Code for Crown Prosecutors Court Service court information and addresses Criminal Justice Service information for victims and witnesses Home Office Code of Practice for Victims of Crime Fraud in the NHS 15

20 Contact your LCFS If you require this information in any other format (i.e. large print, audio, Braille or another language) please call or NHS Counter Fraud Service Fraud in the NHS