ANTI FRAUD AND BRIBERY POLICY

Transcription

1 ANTI FRAUD AND BRIBERY POLICY APPROVED BY: DATE South Gloucestershire Clinical Commissioning Group Board February 2016 Date of Issue: February 2016 Version No: 2.0 Date of Review: February 2018 Author: Sue Brown, Head of Governance and Quality 1

2 Document status: Current Version Date Comments Version 1 March 2013 New Document Version 1.1 December 2015 Version February 2016 Document revised to include NHS Protect Standards for Commissioners Fraud, Bribery and Corruption Amendments following Policy Review Group Version February 2016 Final version following approval by Quality and Governance Committee 2

3 CONTENTS Section Summary of Section Page Cont Contents 3 1 Introduction 4 2 Scope 4 3 Policy Statement 4 4 The definition of fraud 5 5 The definition of bribery 5 6 Why Does South Gloucestershire Clinical Commissioning Group Need To Worry About Fraud and Bribery? 6 7 Why Is an Anti Fraud and Bribery Policy Needed? 7 8 Organisational Values 7 9 Roles and Responsibilities 8 10 Local Procedural documents Equality Impact Assessment Review Date Key Personnel and Contact Numbers National Fraud and Corruption Reporting Line 11 Appendix Appendix A Basic Indicators of Fraud 12 Appendix B How to Prevent Fraud 13 Appendix C What to do if you suspect fraud or bribery 14 Appendix D Acting upon your suspicions the do s and don ts 15 Appendix E Investigation Flowchart 16 3

4 1. INTRODUCTION 1.1 South Gloucestershire Clinical Commissioning Group (hereafter referred to as the CCG) aims to commission prompt high quality treatment and care where it is needed. The CCG is committed to ensuring its resources are protected from fraud, bribery or corruption and are used appropriately and efficiently. It follows that any misuse of resources must be identified and stopped. 2. SCOPE 2.1 The CCG requires all staff and members to act honestly and with integrity and to safeguard the CCG s reputation. It is the responsibility of all staff and members to read and be familiar with the contents of this Policy and related procedures, and to identify and notify the Chief Finance Officer of any suspected cases of fraud or fraud risk. 2.2 This Policy applies to the following All staff, members and lay members engaged by South Gloucestershire Clinical Commissioning Group. Bank and agency staff working for the CCG. Staff providing services to the CCG via a contracted arrangement or Service Level Agreement. Staff on honorary contracts whose payroll costs are partially or fully funded by a third party under a formal arrangement. Trainee professionals and students hosted by the CCG for the provision of work or vocational experience. 2.3 Whilst the CCG aims to demonstrate compliance to NHS Protect Standards for Fraud Bribery and Corruption 1, the oversight of of anti-fraud, bribery and corruption arrangements in place within provider organisations is outside the scope of this policy. 3. POLICY STATEMENT 3.1. Fraud in the NHS is unacceptable and the CCG will not accept any level of fraud or corruption. 3.2 The CCG is committed to maintaining an honest, open and well-intentioned culture. It is committed to the elimination of any fraud within the organisation, and to the rigorous investigation of any such cases. 3.3 Systems and procedures used by the CCG must be designed so that the opportunity to commit theft or fraud or engage in corrupt practices is kept to a minimum. Some basic indicators of fraud are outlined in Appendix A and controls to prevent fraud in Appendix B. 4

5 3.4 Staff are required to promptly report any suspicions of fraud or bribery they may have to the Chief Finance Officer. Guidance for staff who suspect fraud is outlined in Appendices C and D. 3.5 Any case of alleged fraud or bribery found or reported will be investigated and the findings of that investigation acted upon by the CCG. A flowchart detailing the investigation process is provided in Appendix E. 3.6 The CCG will seek the application of the most appropriate, effective and extensive sanctions possible where fraud or bribery is believed to be present. These include disciplinary action, civil recovery and criminal proceedings. 3.7 No member of staff will be penalised for reporting alleged fraud or bribery unless it can be proven they made malicious allegations knowing that there was no reason to suspect fraud or bribery. 4 THE DEFINITION OF FRAUD 4.1 Fraud can be defined as: A dishonest act or omission made with the intention of making a financial gain or causing a financial loss. 4.2 It should be noted that the dishonest act does not need to be successful for fraud to be committed, as long as an intention exists. It should also be noted that the financial gain does not have to be personal but can be for the benefit of another. Fraud By False Representation (S.2) lying about something or misrepresenting a fact by any means, e.g. by words or actions. Fraud By Failing To Disclose Information (S.3) not saying something when you have a legal duty to do so e.g. failing to notify an employer of a criminal conviction or a professional sanction. Fraud By Abuse Of A Position Of Trust (S.4) abusing a position where there is an expectation to safeguard the financial interests of another person or organisation, e.g. an employed carer stealing money from patients he is responsible for. 4.3 This can involve manipulating records including travel claims, petty cash vouchers, or the falsification of invoices for payment. 5 DEFINITION OF BRIBERY 5.1 General bribery offences - Sections 1 to 5 of the Bribery Act 2010 (which replaces all previous statutory and common law provisions in relation to bribery) sets out the "general bribery offences". 5.2 Bribery occurs when a person offers, gives or promises to give a "financial or other advantage" to another individual in exchange for "improperly" performing a "relevant function or activity". 5.3 Being bribed, is defined as requesting, accepting or agreeing to accept such 5

6 an advantage, in exchange for improperly performing such a function or activity. 5.4 A "financial or other advantage" has a wide meaning and could include holidays or entertainment, contracts, non-monetary gifts and offers of employment etc. 5.5 A relevant function or activity covers any function of a public nature; any activity connected with a business, trade or profession; any activity performed in the course of a person s employment; or any activity performed by or on behalf of a body of persons whether corporate or unincorporated. 5.6 The conditions attached are that the person performing the function could be expected to perform it in good faith or with impartiality, or that an element of trust attaches to that person's role. 5.7 Activity will be considered to be "improperly" performed when the expectation of good faith or impartiality has been breached, or when the function has been performed in a way not expected of a person in a position of trust. 5.8 The standard in deciding what would be expected is what a reasonable person in the UK might expect of a person in such a position. 5.9 Any concerns about bribery must be referred to the Chief Finance Officer. 6 WHY DOES SOUTH GLOUCESTERSHIRE CLINICAL COMMISSIONING GROUP NEED TO WORRY ABOUT FRAUD AND BRIBERY 6.1 Even though the vast majority of people are honest and diligent, the CCG cannot afford to be complacent. There is a risk of fraud and bribery from various internal and external sources. The main risk groups have been identified nationally as being: Staff working in health and social care. Contractors providing services on behalf of health and social care services. Suppliers providing goods and services to health and social care. Patients/clients using health and social care services. 6.2 A number of types of fraud affect health and social care services, the main risks coming from: Staff claiming payment for hours not worked or expenses not incurred. Staff working elsewhere whilst on sick-leave. Contractors claiming for services that have not been provided to patients/clients. Overcharging or duplicate invoicing by suppliers. Patients abusing healthcare services e.g. by obtaining drugs or treatment by deception. 6

7 6.3 To mitigate these risks, control and monitoring arrangements need regular review and improvement, such as those in: The monitoring of claims history to identify unusual patterns of behaviour. Budgetary controls such as comparative expenditure data. Authorised signatory controls relating to expenditure. 7 WHY IS AN ANTI FRAUD AND BRIBERY POLICY NEEDED 7.1 The prevention of fraud and bribery and the protection of the CCG's funds is the responsibility of all staff. 7.2 It is important that all staff know: how to identify fraud how to prevent fraud what to do if they suspect fraud 7.3 One of the basic principles of organisations funded by the public sector is to conduct business with probity and to achieve value from public funds. Therefore, it is important that all those who work in the CCG are aware of the risk from fraud and bribery. This document sets out what action should be taken when fraud or bribery is detected or suspected. 7.4 The CCG already has procedures in place that reduce the likelihood of fraud or bribery occurring. These include delegated financial authority, documented procedures, a system of internal control and a system of identifying and assessing risks. In addition, the CCG will ensure that a risk and fraud and bribery awareness culture exists within the organisation. New staff will be made aware of this Policy as part of their Core Induction training. 7.5 This document is intended to provide direction and help in dealing with suspected cases of fraud or bribery. This document is not intended to provide direction on prevention of fraud. 8 ORGANISATIONAL VALUES 8.1 South Gloucestershire Clinical Commissioning Group requires high standards of corporate and personal conduct based on recognition that patient/service users come first. 8.2 There are three crucial values which must underpin the work of the CCG: Accountability: Probity: Everything done by those who work in the CCG must be able to stand the tests of parliamentary scrutiny, public judgements on propriety and professional codes of conduct. Absolute honesty and integrity should be exercised in dealing with patients, assets, staff, suppliers and customers. 7

8 Openness: The CCG s activities should be sufficiently public and transparent to promote confidence between the CCG and its staff, members, stakeholders and the public. 8.3 Neither staff nor their families and friends must profit in any way from their employment within the CCG apart from their salary. Staff must declare any interests, which may prejudice their requirement to act honestly and fairly at all times. 8.4 Staff must be seen to be honest and incorruptible in their dealings with colleagues, service users, other persons or organisations. 9 ROLES AND RESPONSIBILITIES 9.1 All Staff All staff have an implicit duty to protect the assets of the CCG. Assets include finances, information and goodwill as well as property. Some guidance on how to recognise fraud and how to prevent it is attached at Appendices A and B. It is the responsibility of any member of staff who suspects fraud or bribery to report this Under no circumstances should a member of staff speak or write to representatives of the press, TV, radio, or to another third party, about a suspected fraud. The established lines of reporting to the Chief Finance Officer should be used and staff can be reassured that all allegations will be investigated. Nor should the person or persons about whom an allegation is made be informed of the fact without the permission of the Chief Finance Officer. Care needs to be taken to ensure that nothing is done that could give rise to an action for slander or libel. It is also critical not to jeopardise any future investigations. 9.2 Audit Committee The Audit Committee is responsible for monitoring the CCG s counter fraud arrangements, including considering an annual report of counter fraud work. 9.3 Chief Finance Officer The Chief Finance Officer is responsible for: overseeing and providing strategic management and support for all anti-fraud, bribery and corruption work within the organisation; the investigation of any allegations of fraud and bribery and for the delivery of a programme of proactive counter fraud work as detailed in the annual work plan; operational matters such as authorising the investigation of alleged fraud, including the arrest, interviewing and prosecution of subjects and for the recovery or write-off of any sums lost to fraud; and 8

9 informing the Chief Officer and the Chair of the Audit Committee in cases where there may be a substantial loss to the CCG or where the incident may lead to adverse publicity. 9.4 Local Counter Fraud Specialist The LCFS will ensure that all cases of actual or suspected fraud are reported to NHS Protect through the Area Anti-Fraud Specialist (AAFS) before any investigation or referral to the Police takes place The LCFS will liaise with the AAFS and, in conjunction with the Chief Finance Officer, will decide who will conduct the investigation and when / if referral to the Police is required The LCFS will, amongst other duties: ensure that the Chief Finance Officer is kept appraised of all cases; in consultation with the Chief Finance Officer and the AAFS, report any case to the Police as necessary; report the outcome of the investigation to the Chief Finance Officer and the AAFS; ensure that other departments, e.g. Human Resources (HR) are informed where necessary. HR will be informed where an employee is a suspect. (LCFS and HR to comply with the relevant protocol between both parties); and ensure that any system weaknesses identified as part of an investigation are followed through with management to implement changes. 9.5 Human Resources Department A counter fraud investigation differs from that of a disciplinary matter. However, a disciplinary enquiry can proceed in parallel with a criminal investigation as long as there is close co-operation between Human Resources staff; the CCG s investigating officer and the Chief Finance Officer The Human Resources function shall advise those involved in the disciplinary investigation in matters of employment law and in other procedural matters, such as disciplinary and complaints procedures, as required In some cases, such as when a major diversion of funds is suspected, speed of response, including the suspension or re-allocation of members of staff involved, may be crucial to avoid financial loss. 9.6 Internal/External Audit Through their work, Internal and External Audit will be alert to the risk of fraud and bribery. Through on-going liaison with the LCFS, Internal Audit will seek to assess the control measures in place to manage key fraud and bribery risks where these fall within the scope of their audits. 9

10 9.6.2 Any incident or suspicion that comes to Internal or External Audit s attention will be passed immediately to the LCFS. The outcome of the investigation may necessitate further work by Internal or External Audit to review systems. 9.7 Commissioning Support Unit The Commissioning Support Unit (CSU) will assist the Chief Finance Officer and the LCFS, where an employee is suspected of being involved in fraud and/or bribery, by allowing them access to staff and any relevant documentation they may hold. 9.8 Information Management and Technology Information Management and Technology (IM&T) will report all cases to the LCFS where there is suspicion that IT is being used for fraudulent purposes. This includes inappropriate Internet or use HR will be informed if there is a suspicion that an employee has breached the organisation s regulations. 9.9 Communications The CCG will be externally supported by the Communications team, who will assist the Chief Finance Officer and the LCFS in publicising successful local and national cases, and any related articles, newsletters and publicity to raise and maintain awareness Third Parties Acting on Behalf of the CCG Any third party acting on behalf of the CCG shall be responsible for complying with this Policy and other relevant CCG policies, including reporting any concerns / suspicions of fraud and bribery. 10 LOCAL PROCEDURAL DOCUMENTS 10.1 This Policy should be read in conjunction with the CCG s: Whistle-blowing Policy in accordance with the Public Interest Disclosure Act Under the terms of this Act, a member of staff who reports their concerns is protected if they act reasonably and responsibly. Further advice can be sought from the charity Public Concern at Work (telephone ) Standards of Conduct The Policy provides guidance and advice on the offer and/or receipt of gifts, hospitality, sponsorship, or the provision of gifts, hospitality or sponsorship to others in connection with business activities. It also provides guidance on the application of the Bribery Act 2010 and declarations of interests to be made by employees 11. EQUAL OPPORTUNITIES/EQUALITIES IMPACT ASSESSMENT 11.1 An Equality Impact Assessment has been completed for this policy and 10

11 procedure and it does not marginalise or discriminate minority groups. 12. REVIEW DATE 12.1 This policy and procedure will be reviewed after 2 years, or earlier at the request of either staff or management side, or in light of any changes to legislation or National Guidance. 13. KEY PERSONNEL AND CONTACT NUMBERS 13.1 Before utilising communications please note that nominated delegates, such as personal assistants, may also automatically receive copies of s addressed to those in the table below. Therefore direct telephone communication in the first instance may be preferable to maintain absolute confidentiality. Title Name Telephone No. Chief Officer Jane Gibbs Jane.gibbs@southgloucestershireccg.nhs.u k Chief Finance Officer Sharon Kingscott Sharon.kingscott@southgloucestershireccg. nhs.uk Head of Sue Sue Governance and Brown Brown@southgloucestershireccg.nhs.uk Quality 4439 Clinical Chair Jon Hayes Jonathan.Hayes@southgloucestershireccg. nhs.uk Chairman of John John.rushforth@uwe.ac.uk 0117 Audit Committee Local Counter Fraud Specialist Rushforth Sandra Bell sandra.bell5@nhs.net NATIONAL FRAUD AND CORRUPTION REPORTING LINE 14.1 As an alternative reporting channel, the NHS Fraud and Corruption Line can be used in confidence on to report any concerns about fraud or corruption Public Concern at Work Public Concern at work is an independent charity that provides free advice for employees who wish to express concerns about fraud or other serious malpractice 11

12 APPENDIX A BASIC INDICATORS OF FRAUD All Managers should ensure that controls are in place to prevent and detect fraud and error. However, fraud involves the falsification of records and managers need to be aware of the possibility of fraud when reviewing or being presented with claims and forms. Whilst by no means being proof on their own, the circumstances below may indicate that fraud or bribery are taking place, and should therefore put managers / employees / Board members on the alert. Contractors / Suppliers / Third Parties Invoices being submitted on non-headed paper. Altered documents (correcting fluid, different pen or handwriting). Requests for payment for goods/services that have not yet been delivered. Submission of duplicate invoice. Notification of an organisation s bank details changing. Tender submissions which are priced much higher or lower than other submissions. Complaints from public or staff regarding service quality. Unexpected requests for an additional fee or commission to "facilitate" a service. Requests that you provide employment or some other advantage to a friend or relative; Requests to use of an agent, intermediary, consultant, distributor or supplier that is not typically used by or known to the CCG; and Offers of an unusually generous gift or hospitality by a third party. Employees Altered documents (correcting fluid, different pen or handwriting). Changes in normal patterns of, for example, cash takings or expense claim details. Text erratic or difficult to read or with details missing. Delay in completion or submission of expense claim forms. Lack of vouchers or receipts in support of expense claims. Seemingly living beyond their means. Under constant financial or other stress. Choosing not to take annual leave (and so preventing others becoming involved in their work), especially if solely responsible for a risk area. Always working late. Refusal of promotion. Insistence on dealing with a particular individual. Complaints from public or staff regarding service quality. 12

13 APPENDIX B HOW TO PREVENT FRAUD Whilst it is impossible to create a 100% fraud-proof system, managers must ensure the systems they operate include a reasonable number of effective controls designed to detect and prevent fraud and error. The actions and controls managers should consider are as follows: Document procedures and controls, and train all staff in their use. Where CCG-wide procedures apply, ensure staff are aware and trained in them. Managers should check compliance to the procedures. Separation of duties between staff and staff rotation. Avoid a single employee being solely responsible from initiation through to completion of a transaction. Introduce adequate internal checks. Most simply this involves an independent officer checking work, calculations or documents prepared by the initiating officer. For example, a manager could check a travel claim against original work records, e.g. diaries, or Auto-route could be used. Expenses to be supported by appropriate receipts. Ensure the prior documented approval of expense generating courses, visits etc. Cross out the uncompleted part of claim forms, thereby making the addition of further expenses after approval more difficult. Minimise cash/stock holdings. Bank cash/cheques regularly, at least weekly, possibly more frequently depending on the value and the risk. Review budget statements and other management information, and follow up variances. For example: - why has x dropped by 50% - why expenditure on travel is exceeding the budget by 50% etc 13

14 APPENDIX C WHAT TO DO IF YOU SUSPECT FRAUD OR BRIBERY A report should be made as soon as there is a suspicion of fraud or bribery. You should report your suspicions to the Chief Finance Officer (see Section 13.1 for contact details) without delay. Under no circumstances should you begin your own investigation. Managers should seek advice from the Chief Finance Officer where they have any doubts about whether or not a referral should be made. In all cases the Chief Finance Officer will ensure that the suspicions or concerns raised are investigated strictly in accordance with the CCG s policies. Anonymity Unless there are truly exceptional reasons, suspicions of fraud or bribery should not be reported by an anonymous letter or telephone call, as this can seriously limit the scope of any investigation because often too little information is disclosed. Please consider other options. However, when requested it shall be the policy of the CCG to take such steps as can reasonably be expected to protect the identity of the person making the report of suspected fraud or bribery. Confidentiality You should ensure that you do not discuss your suspicions with anyone else that you work with. This will protect your anonymity (should you wish) and will ensure that evidence is not tampered with. 14

15 ACTING UPON YOUR SUSPICIONS THE DO S AND DON TS If you suspect fraud or bribery within the workplace, there are a few simple guidelines that should be followed: DO: APPENDIX D Make an immediate note of your concerns. Where possible note all relevant details, such as what was said in telephone or other conversations, the date, time and the names of any parties involved. Convey your suspicions to someone with the appropriate authority and experience, as set out within the Anti-Fraud and Bribery Policy. Deal with the matter promptly. Any delay may cause the CCG to suffer further financial loss. DON T: Do nothing. Be afraid of raising your concerns. You will not suffer any recrimination from the CCG as a result of voicing a reasonably held suspicion, and any matter you raise will be dealt with sensitively and confidentially. Approach or accuse any individuals directly. Try to investigate the matter yourself. There are special rules surrounding the gathering of evidence for use in criminal cases. Any attempt to gather evidence by people who are unfamiliar with these rules may compromise the case. Convey your suspicions to anyone other than those with the proper authority. 15

16 APPENDIX E INVESTIGATION FLOWCHART Fraud Referral to Chief Finance Officer (CFO) No Fraud case to answer Initial review meeting between CFO and relevant Strategic Director Fraud case to answer CFO instructs an investigation Investigator to advise CFO and Strategic Director of action required (Criminal, disciplinary or Civil). Case report prepared Investigator updates CFO; notify Audit Committee when fraud substantiated. Sanction Decision by CFO, Strategic Director and Director of Human Resources DISCIPLINARY CIVIL CRIMINAL Strategic Director considers disciplinary action and advises HR who appoint HR Investigation Officer Prosecution file prepared by Investigator Consider County Court / small Claims in consultation with CCG solicitors SANCTION AND REDRESS ACTION AND OUTCOME 16