Posts Tagged ‘Fraud’

Medically unqualified clinical director jailed

By Mike Broad - 25th October 2011 9:50 am

A man who posed for years as a qualified doctor by hijacking a genuine GP’s medical credentials has been jailed after a major fraud investigation by NHS Protect.

Luis Conrad de Souza, 53, of Whitmore Road, Beckenham, Kent, was also sentenced at the same court for supplying another person’s DNA to the Child Support Agency in order to disclaim paternity for his child.

He was jailed for 27 months in total: for the NHS offences he received 18 months in prison, and for the CSA-related offences he received 9 months, to be served consecutively.

Against the NHS, he committed two offences of Obtaining a Pecuniary Advantage by Deception, contrary to Section 16 of the Theft Act 1968. A charge of possession of an article for use in fraud, contrary to Section 6 of the Fraud Act 2006, was left by the court to lie on file.

De Souza received at least £361,000 of NHS money in fraudulently obtained earnings. He sustained the lie that he was a qualified doctor for many years, enabling him to work in well-paid strategic roles for Lewisham Primary Care Trust from 2001 to 2010.

His first role with Lewisham PCT, as head of commissioning and service development in 1999, required ‘education to degree level or equivalent’. In 2001, de Souza began work as a clinical adviser, which required a degree and clinical specialisms. In 2002, he completed a skills and experience summary and stated he was a fully-qualified GP.

In 2005 he obtained the post of clinical director of the South East London Clinical Cardiac Network (SELCCN), now known as the South London Cardiac and Stroke Network. It was essential for applicants to have a degree and clinical experience, but he had neither. However, his jobs did not require him to have direct contact with patients.

His CV stated that he had a Bachelor of Medicine and Bachelor of Surgery (MBBS) from Charing Cross Hospital Medical School, University of London, dated 1991 but the university’s records show that in fact he attended another of their colleges and he dropped out after two years.

He also claimed to have a BSc (1st Class Honours) in Biochemistry and Chemistry from the University of Cambridge, dated 1987. But Cambridge holds no record that he studied there either.

De Souza resigned from Lewisham PCT, on an unrelated matter, in August 2010.

Mick Hayes, anti-fraud lead at NHS Protect, said: “NHS Protect worked in partnership with Lewisham PCT and the Metropolitan Police to investigate Luis Conrad de Souza. This fraud was unusually large, and was a serious abuse of his high position in the NHS. The actions of NHS Protect have prevented him from continuing his criminal career inside the NHS. His conviction sends out the message that NHS Protect will always take reports of fraud seriously and an investigation will be launched wherever appropriate. We pursue all available sanctions to deter others from attacking valuable NHS resources.”

Financial analyst jailed for defrauding doctors

By Mike Broad - 12th July 2011 10:24 am

An NHS financial analyst and four accomplices have been sentenced for conspiring to defraud the NHS.

Analyst Lance Sewell was working at Guy’s & St Thomas’s NHS Foundation Trust when he diverted payments of £61,876.30 in total.

In January 2009, the bank details of four doctors were changed without their knowledge and their monthly salaries were diverted to other bank accounts to the tune of £16,402.

In July 2009, the trust’s accountants spotted suspicious alterations to an authorising manager’s signature. After some initial enquiries it was established that the trust was being targeted with the submission of fraudulent invoices. The audit team found that the payroll and invoice frauds were linked to a common bank account.

Nearly £100,000 worth of fraudulent invoices were also submitted but not paid due to the diligence of trust staff.

Sewell of Moremead Road, Catford, received 21 months in prison.

As the scale of the frauds became clear, NHS Protect, which handles larger, more complex and cross-boundary frauds, was called in to investigate. It gathered extensive evidence from payroll and creditor payment records and the audit team.

Mark Howard, London Area Anti-Fraud Specialist for NHS Protect, said: “This was a sustained and determined attack on NHS funds. The group kept changing its tactics to try and stay one step ahead of being detected, but failed, and these young men must now pay the price for their crimes. Who knows how much more they would have stolen from the NHS had we not stopped them.”

NHS fraud cases rise significantly over three years

BBC Health - 25th January 2011 1:47 pm

The number of fraud cases investigated in the NHS has risen by 37% in the last three years, official figures show.

NHS Counter Fraud Service figures showed the number of cases of potential fraud detected and investigated rose from 351 in 2007/8 to 415 in 2008/9 and 482 in 2009/10.

Problems include unpaid prescriptions and staff claims for unworked shifts.

According to the figures, the value of fraud and unlawful action identified was £4.1m in 2007/8, £16.2 in 2008/9 and £10.9 in 2009/10.

The organisation said recurrent kinds of fraud related to staff and professionals claiming money for shifts not worked, which is known as “timesheet fraud”, and employees working in unauthorised jobs while on sick leave.

Other categories included patients who might try to avoid paying prescriptions by falsely claiming exemptions or using aliases to obtain drugs, and contractors or suppliers attempting to exaggerate records of NHS work.

Read more at BBC Health.

Think carefully before calling in the fraud squad

By Stephen Campion, HCSA chief executive - 27th October 2009 6:36 pm

“Does your wife, or anyone else, drive your car doctor?” was, I thought, a strange question to be asked of a consultant by a clinical director.

But apparently someone - motive as yet unclear - thought his job plan meant he should have been somewhere else other than the local private hospital. So, rather than the trust first simply checking his diary and the job plan, officers of the NHS Fraud Squad instead spent months trying to get pictures of his car parked at the aforementioned private hospital.

They only succeeded in getting four pictures. Goodness knows how much time they spent hiding in the rosebushes waiting to take pictures of the car that “did not attend”.  

What a waste of money! That it was parked there was never going to be a contested issue. Just how much is being paid by way of covert surveillance, and how far are we from becoming a ‘stitch up’ society?  

Few would argue that fraud, when uncovered, means the perpetuator should be bought to account. But I would also like to think that we are living in a fair society and that the NHS should only revert to secret-service style tactics after very careful thought.

This is by no means the first occasion that I have encountered consultants being subject to such scrutiny and they might never find out if they have, if the fraud squad decides that there is insufficient evidence to proceed.

I was involved in one case where the NHS Fraud Squad involved the Crown Prosecution Service who determined there was no basis to proceed; but the trust went ahead anyway because the lesser burden of proof was in its favour. More often than not these Fraud Squad activities take place with the ‘suspect’ completely unaware of what is going on.

My point is that if the employer suspects infringement of the rules, is it right to go straight to the world of hidden cameras and enforcement officers hiding in the hedgerows at vast public expense? Or would it be better if a quiet word was first spoken in the ear?

Clearly much will depend on the severity of what is being investigated; and whether the source of the information is credible as opposed to malicious - and there are far too many of those. But I just worry that the fraud squad is becoming a weapon of first rather than last resort. Either way it saddens me that spy cameras seem as much part of the NHS, as speed cameras are to local authority revenue streams. 

NHS trusts turn to ‘no win, no fee’ approach on fraud

BBC Health - 8th October 2009 10:28 am

The NHS is turning to no win, no fee legal representation - despite being a persistent critic of the practice.

The health service has spent the last few years complaining the no win, no fee culture has led to a rise in costs incurred in medical negligence cases.

But the NHS Counter Fraud Service is now embracing the system after reaching an agreement with a law firm in a bid to recoup more money lost to fraud.

About £6m a year is returned to the NHS following legal action against fraudsters - although the true value of the crime is much higher. Fraud cases can run into hundreds of thousands of pounds with some of the biggest crimes involving companies with NHS contracts for things such as cleaning, catering and buying, incorrectly billing for work and health workers, such as GPs, pharmacists and dentists, falsifying charge sheets.

Patient groups accused the NHS of double standards.

Half of the medical negligence cases the NHS deals with now are brought on a no win, no fee basis whereby lawyers get paid only if they win the case, which some believe encourages more legal actions.

Nonetheless, the Fraud Service, which supports individual trusts in bringing action, believes the agreement with law firm Capsticks will help the service recoup money.

Read more at BBC Health.