'Down these mean streets a man must go who is not himself mean', crime writer Raymond Chandler famously wrote of the archetypal detective. Now NHS managers are getting mean in a bid to beat the criminals who defraud the NHS of tens of millions of pounds every year.
They are to be given the chance to study detective skills as part of a degree in criminology.
Such is the complexity of prescription or 'item of service' fraud in primary care, and contract fraud in hospitals and community trusts, that NHS staff are being taught skills including surveillance procedures, investigative interview techniques and the law.
Jim Gee, director of the NHS directorate of counter-fraud services, says the true extent of health service fraud is unknown but the government's efficiency scrutiny of prescription fraud found losses ranged from between 3 and 8 per cent. Mr Gee says the more his detectives look, the more they find.
To make their work easier, staff are being offered a modular course teaching the rudiments of modern anti-fraud procedures, leading to a certified counter fraud specialist qualification in public sector investigation and criminal justice studies. This can be used as the basis of a 12-month BSc degree in criminology related to fraud. An MSc is also offered.
The modular course is a collaboration between the DCFS and the Institute of Justice Studies at Portsmouth University. Mr Gee insists it's a long way from trenchcoat and trilby classics.
'We are not characters out of Raymond Chandler. Investigating fraud is a professional area and we need highly skilled people to do it. As fraud becomes more sophisticated, staff need to know how to gather evidence and carry out investigative interviews. '
The course is just one element of a new professional approach to eradicating fraud and clawing back stolen funds, says Mr Gee.
'We want to get the message to criminals that the NHS is no longer a soft touch. They are starting to take us seriously. For many years the NHS had been held in contempt. '
As an example of the new attitude to NHS fraudbusters, Mr Gee said one preliminary phone call to a contractor about the possibility that they had submitted false claims for services to the NHS resulted in 'an immediate offer of a£1. 75m refund'.
The DCFS employs over 110 people, but as many as 500 staff working in anti-fraud services across primary care, community and secondary services have taken up the offer of formal anti-fraud training.
Primary care fraud accounts for around half of the detected fraud. And some believe temptation could be removed if GPs became NHS employees instead of independent contractors.
The Association of Community Health Councils for England and Wales is among those who believe the complex system of reimbursement for items of service delivered and capitation payments per patient is a temptation too far for the corrupt.
Detectives say they are frustrated by complex paper-trails which sometimes involve tracking down many thousands of false prescriptions, item of service claims or visits.
Detective Superintendent James Perry, who leads the Metropolitan Police public sector fraud squad, says better police and DCFS co-operation has led to higher conviction rates.
But he adds that the system of reimbursement is 'overly bureaucratic' and 'leaves the door open for a small percentage of GPs to exploit it'.
While not backing the ACHCEW call for all GPs to be salaried NHS employees, Mr Gee agrees that problems of fraud 'usually go back to the 1947 NHS Act - there are a lot of complex and vague regulations in it'.
Anyone interested in foundation level anti-fraud training should contact David Snell at the Department of Health on 020-7210 5281 or e-mail: dsnell@doh.gov.uk
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