The NHSCFA estimates that the NHS is vulnerable to £35.2 million worth of fraud against NHS Resolution administered funds each year.
Fraud against NHS Resolution relates to fraudulent accidents/ insurance claims under the Liabilities to Third Parties Scheme (LTPS) or through clinical negligence. Fraud is a significant risk for NHS Resolution, who manage negligence claims on behalf of their members.
The main fraud types in this category are:
- The serious exaggeration of legitimate claims for damages. For example, the claim does not reflect the actual harm suffered.
- The falsification of the circumstances which led to a claim for damages being made. For example, the incident did not occur as described.
NHS Resolution is directly funded by the health service. Fraud against NHS Resolution means fewer resources are available to be spent on frontline health services such as patient care, health care facilities, doctors, nurses and other staff.
NHS Resolution examines all claims and where there is a legitimate claim, they will pay an appropriate level of compensation. Where they believe a claim to be fraudulent, they will always investigate, regardless of the size of claim and will pursue the case.
To assist you on how to spot the signs of fraud against NHS resolution and how stop this type of fraud, please see below.
- Are you aware of anyone exaggerating an injury to make a claim against NHS Resolution? For example, you are claiming you are not able to work or perform normal tasks, when this is untrue.
- Have you falsified the circumstances of your claim against NHS Resolution?
- Are you aware of anyone who has submitted a fraudulent claim against NHS Resolution?
An individual who fraudulently claimed £837,109 from an NHS trust for negligence was jailed for three months after having been found in contempt of court.
The individual was subjected to a physical attack in 2008 and sought medical assistance for his injuries subsequently said the treatment he received for fractures of two fingers and a laceration of the lower lip were negligent, leaving him unemployed and dependent. In 2011 NHS Resolution offered £30,000 to settle the case, but this offer was declined.
Over the next five years, the individual systematically fabricated and exaggerated his claim, seeking £837,109 for future care and loss of earnings. Suspicions were raised and video surveillance as part of civil proceedings in 2015, exposed him working and lifting heavy items. In April 2018, the individual was found guilty of 14 counts of contempt of court and in June 2018 he was jailed for three months.
How to report fraud
Report any suspicions of fraud or attempted fraud to the NHS Counter Fraud Authority online at https://cfa.nhs.uk/reportfraud or through the NHS Fraud and Corruption Reporting Line 0800 028 4060 (powered by Crimestoppers). All reports are treated in confidence and you have the option to report anonymously. You can also report to your nominated Local Counter Fraud Specialist if you are an NHS employee or contractor.