NHS counter fraud investigations

Counter-fraud investigations in the healthcare sector must be handled exceptionally carefully by experienced experts. We are frequently instructed to advise and represent practitioners who have been asked to attend interviews under caution with the counter-fraud service. 

We help practitioners formulate a response to the initial disclosure from the counter-fraud investigators and advise on interview preparation, whether that is by drafting a prepared statement or advising on what to expect at interview.

In our experience, the two allegations most commonly investigated by NHS counter-fraud are:

• Claims made by dentists for Units of Dental Activity (UDAs): We regularly advise practitioners with counter-fraud investigations that relate to alleged impropriety around claiming UDAs. The rules and regulations governing financial claims for NHS dentistry are complex, and we know them well. That knowledge, together with our knowledge of the dental profession, its regulation and NHS dental practice allows our expert fraud defence solicitors to provide support throughout the counter fraud investigation and any related GDC hearings or Performers List investigations.
• Allegations against hospital doctors working privately in NHS job-planned time. Many doctors believe that as long as NHS time is made up elsewhere, when they fulfil their NHS responsibilities is up to them. That is not the view taken by the counter-fraud service. Often despite a lack of awareness on the practitioner’s part, this worrying allegation can be pursued and lead to serious consequences for a hospital doctor. We have represented many practitioners who have faced in these circumstances.  

If a counter-fraud investigation finds evidence of fraud, the consequences for a healthcare practitioner are likely to be significant. There are a range of outcomes that arise from an investigation by NHS counter-fraud, including:

• Prosecution in the courts with the risk of conviction and imprisonment;
• Disciplinary action by an employer, including dismissal; and
• A requirement to repay any overpayments, potentially resulting in a claim pursued in the civil courts to recover funds.

Based on our decades of experience advising healthcare professionals, we believe that seeking early legal advice when the allegations are first notified to you is vital; it allows time to prepare a detailed response, to gather supporting information and to agree the clear message to be communicated to the counter fraud service. 

Even if a counter-fraud investigation does not result in any criminal action, there is still the risk of referral to your regulator, or employment action based on the same facts.  Our experienced fraud defence solicitors will help you mitigate those risks. If they cannot be avoided, our wider healthcare regulatory expertise enables us to provide continuity of representation if required.