Jim Gee, ex-director of NHS Counter Fraud Services said that fraud is costing the NHS £5bn a year, with a further £2bn lost to financial errors.
The amount estimated by Mr Gee, who led the NHS anti-fraud section for eight years until 2006, is 20 times that recorded in the government’s annual fraud indicator report. It is based on worldwide figures, which suggest average losses to fraud and error of just under 7% of healthcare budgets.
Key types of fraud include the non-payment of prescription charges by patients, medical professionals claiming for work they have not done and overcharging by contractors. Mr Gee said, “we need to not be embarrassed, or in denial, about the possibility of fraud taking place in the NHS. We need to get on with tackling the problem, minimising its cost, maximising resources available for proper patient care.”
Last year NHS Protect, with its local investigators oversaw nearly 150 successful criminal cases. There were also 435 civil or internal disciplinary actions. However, NHS Protect only proceeds with the cases if it has a reasonable chance of winning and budget cuts has meant that it is more difficult to gather evidence than it used to be.
Mr Gee said that the NHS should prioritise fighting fraud. He said, “I think fraud is one of the last great unreduced healthcare costs. And to me, putting money into it makes absolute sense. It’s one of the least painful ways of cutting costs. It makes absolute sense to cut the cost of fraud before you cut the quality, or extent of patient services.”
The Department of Health in a statement said “it did not recognise” the figure or “speculate on levels of losses” and said NHS Protect had a “significant budget” and “protects and safeguards frontline NHS services”.