Ex-counter fraud boss says NHS Wales 'losing millions'

The Welsh NHS could be losing up to £200m a year through fraud and not enough is being done to tackle it, a former NHS counter fraud boss has said.

Examples of fraud can include doctors and dentists writing bogus bills or even making up patients.

In 2016-2017 the NHS Counter Fraud Service in Wales recovered just under £350,000.

In a statement it said it did not recognise the figures provided for estimated losses.

Jim Gee, former chief executive of the NHS Counter Fraud Service for Wales and England, said the losses could be in the "hundreds of millions" in Wales and that investigators were "grossly under-resourced".

Examples of fraud in the NHS in Wales include gynaecologist Dr Anthony Madu who was ordered to pay back £70,000 after carrying out locum work at hospitals while suspended and later on paid sick leave from Cardiff and Vale University Health Board.

Another is dentist Jochemus Venter who practised in Llandrindod Wells and claimed £48,000 for treatment he had often not carried out.

The Welsh NHS has three levels of counter fraud service: local specialists in each health board; a central service; and access to specialists from the NHS in England.

However Mr Gee, now a partner at an accountancy firm who worked on the latest Annual Fraud Indicator, believes this is not enough.

He said: "I think the thing the public don't understand is how little is spent on protecting their NHS from this kind of abuse. I think they would be shocked if they heard the level of resource.

"People would expect more resourcing - and the resourcing has to be used in a more effective way."

The Centre for Counter Fraud Studies, a specialist research centre at Portsmouth University, estimates the NHS in Wales could be losing between £175m-£200m a year through fraud.

It says most of the money is lost through procurement fraud, suppliers overcharging the NHS for goods, which it says is often a low-value high-volume crime which can be difficult to detect.

In 2016-2017 investigators at the Welsh NHS Counter Fraud Service recovered £335,127.

Since its inception in 2001 the Welsh NHS Counter Fraud Service has recovered in excess of £7m.

There are six experienced investigators in Wales and 20 specialists based in health boards across Wales.

However, Prof Mark Button from the Centre for Counter Fraud Studies believes this is not enough people to tackle a potential £200m problem.

He said: "That is clearly not enough staff. There needs to be many more staff employed to pursue a wide range of strategies to deal with the problems of fraud in the NHS."

In a lengthy statement NHS Wales said it "did not recognise" the figures supplied by the Centre for Counter Fraud Studies.

It said there had been investment in investigators and there was a "zero tolerance approach" to economic crimes, while a recent independent internal review highlighted the "high standard of counter fraud work in NHS Wales".

"Counter fraud investigators work closely with NHS colleagues in audit, finance and post payment verification services to identify possible fraud risks, address any system weaknesses and ensure that all potential fraud concerns are professionally investigated," a spokesman added.