NHS Requirement 8:

The organisation uses the approved NHS fraud case management system to record all incidents of reported suspect fraud, bribery and corruption, to inform national intelligence and NHS counter fraud functional standard return submission by the NHSCFA. The case management system is used to record all fraud, bribery and corruption investigative activity, including all outcomes, recoveries and system weaknesses identified during the course of investigations and/or proactive prevention and detection exercise.

Organisation meets the requirement

There is evidence to indicate that the completeness and timeliness of information recorded on the approved NHS fraud case management system is regularly and soundly evaluated and that, where appropriate, findings lead to improvements.

All relevant investigation materials, for example witness statements, investigation plans and exhibits, are uploaded to the approved NHS case management system in a timely manner.

The provision of approved NHS fraud case management system data to inform national intelligence and functional standard return is regularly and soundly reviewed and, where appropriate, findings lead to improvements.

Organisation partially meets the requirement

The organisation records all reports of suspected fraud, bribery and corruption, investigative activity, including all outcomes, recoveries and system weaknesses identified during the course of investigations and/or proactive prevention and detection exercises, on the approved NHS fraud case management system in line with NHSCFA guidance.

All relevant investigation materials, for example witness statements, investigation plans and exhibits, are uploaded to the approved NHS fraud case management system.

Organisation does not meet the requirement

The organisation does not use the approved NHS fraud case management system to record all reports of suspected fraud, bribery and corruption, investigative activity, including all outcomes, recoveries and system weaknesses identified during the course of investigations and/or proactive prevention and detection exercises.

The organisation may be recording some reports of suspected fraud, bribery and corruption, investigative activity, including all outcomes, recoveries and system weaknesses identified during the course of investigations and/or proactive prevention and detection exercises, on the approved NHS fraud case management system but this is not done in a comprehensive or timely manner and/or it is not done in line with NHSCFA guidance.

Guidance, supporting documentation and evidence

Organisations should consider the following (the list is not exhaustive):

  • NHS Counter Fraud Manual
  • The NHSCFA Investigation Case File Toolkit now incorporated in the NHS Counter Fraud manual
  • The NHSCFA instructions and guidance on the use of the approved NHS fraud case management system
  • Approved NHS fraud case management system records
  • Approved NHS fraud case management system weakness records
  • Investigation files
  • Evidence of proactive prevention and detection exercises
  • Evidence of review
  • Correspondence with third parties including the Crown Prosecution Service and the NHSCFA
  • All sanctions achieved are recorded as soon as is reasonably practicable
  • Cases are closed on the approved NHS fraud case management system within one month of the conclusion of a case, with all relevant fields completed