Agenda item134 SUBJECT Policy for the application of sanctions

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					                                                                               Agenda item:13.4




SUBJECT                                Policy for the application of sanctions In respect of fraud and
                                       corruption
SPONSORED BY                           David Stonehouse, Director of Finance

PRESENTED BY                           Stevan Burtenshaw – Local Counter Fraud Specialist (LCFS)

SUBMITTED TO                           Audit Committee 4th December 2009
                                       PCT Board January 2010
PURPOSE OF PAPER                       For approval

EXECUTIVE SUMMARY:
This is a new PCT Policy that sets out the broad principles for the consistent application of appropriate
sanctions whenever fraud or corruption is detected against the interests or assets of NHS Norfolk.

For counter fraud work to be effective it is essential that NHS Norfolk has in place a policy which
ensures that the widest range of possible sanctions are applied, commensurate with the seriousness
of each case, with due consideration of possible constraints which may effect successful outcomes.

A key recommendation made in the NHS Counter Fraud Security Management Service (CFSMS)
Compound Indicator (CI) performance report was to have a live/working Sanctions and Redress
Policy. Having this policy in place will enhance the PCTs chances of scoring a level 3 as appose to a
level 2, which was achieved in 2008/09. The CI scores range from a level 1 to a level 4 rating.
KEY RISKS:
The key risk of not having this policy in place is the inability to conduct counter fraud work effectively
and not applying the appropriate sanction. Other risks are not complying with CFSMS Fraud and
Corruption Manual and also Secretary of State Directions.
Finance and performance:
Risk of failure to meet Compound Indicator targets.
Risk of not delivering VFM services.
Impact Assessment (environmental and equalities):
Impact scanned and no adverse impacts were identified from this policy.
Reputation:
Risk to reputation of failure to meet Annual Health Check performance targets
Risk to reputation with stakeholders
REFERENCE TO RELEVANT STANDARDS FOR BETTER HEALTH/USE OF RESOURCES,
BOARD ASSURANCE FRAMEWORK, STRATEGIC/OPERATIONAL/ORGANISATIONAL
DEVELOPMENT PLANS AND NHS CONSTITUTION
This policy supports NHS Norfolk in its compliance with the DOH, NHS Counter Fraud Security
Management Service CFSMS and Secretary of State Directions (SoSD).
Standards for Better Health Standard C7d – ensure financial management achieves economy,
effectiveness, efficiency, probity and accountability in the use of resources.
RESOURCE REQUIRED (if appropriate):
No new or additional resources required at this stage
REPORT DISCUSSED WITH (please specify if been to MEX/CLEX):
Policy & Procedures Group on the 18/11/09 and the Audit Committee on the 04/12/09
RECOMMENDATION:
The Board is asked to approve this policy




                                                                                               1
 Title                              POLICY FOR THE APPLICATION OF SANCTIONS
                                    IN RESPECT OF FRAUD AND CORRUPTION
 Description of policy              The purpose of this policy is to set out the broad principles for
                                    the consistent application of appropriate sanctions whenever
                                    fraud or corruption is detected against the interests or assets of
                                    NHS Norfolk.
 Scope                              For counter fraud work to be effective it is essential that NHS
                                    Norfolk has in place a policy which ensures that the widest
                                    range of possible sanctions are applied, commensurate with the
                                    seriousness of each case, with due consideration of possible
                                    constraints which may effect successful outcomes.
 Prepared by                        Stevan Burtenshaw - Local Counter Fraud Specialist
 Impact Assessment                  Impact scanned and no adverse impacts were identified from
 (Equalities and                    this policy.
 Environmental)
 Other relevant approved            Counter Fraud and Corruption Policy
 documents                          Openness Policy
                                    Standards of Business Conduct Policy
                                    The Disciplinary Policy
 Evidence base /                    Level of Evidence:
 Legislation                        B. mix of national and local consensus
 NHSLA Risk Manag.                  This policy supports NHS Norfolk in its compliance with the
 Standards / Standards              DOH.
 for Better Health                  Standards for Better Health in reference to:
                                    Standard C7d – ensure financial management achieves
                                    economy, effectiveness, efficiency, probity and accountability in
                                    the use of resources.
 Consultation on                    David Stonehouse – Director of Finance
 document                           Jonathan Cook – Director of Corporate Services
 Training implications              N/A
 Monitoring and audit               See section 3.3.9.
 Dissemination                      Is there any reason why any part of this document should not
                                    be available on the public web site?    Yes / No X
 Approved by                        NHS Norfolk Audit Committee, NHS Norfolk Policy and
                                    Procedures Group and NHS Norfolk Board.
 Authorised by                      NHS Norfolk Audit Committee, NHS Norfolk Policy and
                                    Procedures Group and
                                    NHS Norfolk Board.


Policy for the Application of Sanctions              1 of 7                   Version: 1 December 2009
In Respect of Fraud and Corruption
NHS Norfolk
 Review date and by                 December 2011 (Reviewed every two years)
 whom
 Date of issue                      December 2009




Policy for the Application of Sanctions             2 of 7              Version: 1 December 2009
In Respect of Fraud and Corruption
NHS Norfolk
    Title: Policy for the Application of Sanctions in Respect of Fraud and
    Corruption.

    Contents

                                                                               Page
Section

1          Introduction                                                        4
2          Sanctions Available                                                 4
2.1        Criminal Proceedings                                                4
2.2        Civil Proceedings                                                   4
2.3        Employment/Disciplinary Proceedings                                 5
3          Procedural Policy for all Issues of Sanction and Redress            5
3.1        General Principle                                                   5
3.2        Lead Responsibility                                                 5
3.2.1      Evidence                                                            5
3.2.2      Alerting Suspects                                                   5
3          Progression of Actions                                              6
4          Professional and Ethical Considerations                             7
5          Summary                                                             7
6          Local Counter Fraud Specialist Contact Details                      7
Appendices
Appendix A         N/A
Appendix B         N/A

    Version Control (To be completed by policy owner)

    Version        Date            Author      Status           Comment
    1           28/10/09 Stevan               Approved
                         Burtenshaw           by NHSN
                                              P&P
                                              group on
                                              18/11/09


    Policy for the Application of Sanctions   3 of 7        Version: 1 December 2009
    In Respect of Fraud and Corruption
    NHS Norfolk
               POLICY FOR THE APPLICATION OF SANCTIONS
                 IN RESPECT OF FRAUD AND CORRUPTION


1 Introduction

The purpose of this policy is to set out the broad principles for the consistent
application of appropriate sanctions whenever fraud or corruption is detected against
the interests or assets of NHS Norfolk.
For counter fraud work to be effective and in accordance with the Secretary of State
Directions, it is essential that NHS Norfolk has in place a policy which ensures that
the widest range of possible sanctions are applied, commensurate with the
seriousness of each case, with due consideration of possible constraints which may
effect successful outcomes.
This policy is a corollary to the NHS Counter Fraud and Corruption Manual and the
Fraud and Corruption Policy, which has set out roles and responsibilities in detecting
and investigating fraud, and corruption. The consistent implementation of this policy
will be a natural cognate to all fraud investigations.

2 Sanctions Available

There can never be a policy, which provides that all sanctions that can be applied
should be applied in every case. Such a policy would be unworkable, might give rise
to legal challenge on the basis that it is unreasonable and would fetter the discretion
of the NHS Counter Fraud Specialists.

However it is essential that all available sanctions are considered at the earliest
opportunity. The broad principles of the policy are as follows:

2.1 Criminal Proceedings

A range of criminal offences may be relevant to a criminal prosecution for fraud.
The Director of Finance further to advice given by the Local Counter Fraud Specialist
will make a decision on the potential pursuance of criminal proceedings at the
earliest opportunity.

2.2 Civil Proceedings

Where the evidence obtained in a fraud investigation shows that monies have been
dishonestly misappropriated, the Director of Finance further to advice given by the
Local Counter Fraud Specialist will make a decision on the potential pursuance of
recovery of loss at the earliest opportunity.




Policy for the Application of Sanctions     4 of 7           Version: 1 December 2009
In Respect of Fraud and Corruption
NHS Norfolk
2.3 Employment/Disciplinary Proceedings

Once any investigative work undertaken provides prima facie evidence of fraudulent
activity, the Director of Finance will immediately liaise with the Director of Human
Resources, in conjunction with the Local Counter Fraud Specialist, to determine the
potential pursuance of any employment and disciplinary sanctions to be involved.


3. Procedural Policy for all Issues of Sanction and Redress

3.1 General Principle

It is recognised that traditional thinking and historic actions have resulted in criminal,
civil and disciplinary proceedings being taken forward separately, however this
approach has often resulted in unsatisfactory outcomes with each individual type of
proceeding potentially compromising one or both of the other avenues of redress.
It is the policy of NHS Norfolk that as far as is possible, parallel sanctions will be
applied simultaneously to maximise the penalties against those who cause loss to
healthcare provision by the misappropriation of NHS Norfolk’s assets and/or funds.

3.2 Lead Responsibility

Under the Secretary of States Directions for Countering Fraud within the NHS, it is
the responsibility of the Director of Finance, as advised by the Local Counter Fraud
Specialist, to determine what sanctions and redress actions are appropriate to the
circumstances of each identified fraud.
The crucial determinatives for the effective application of all potential sanctions are:

3.2.1 Evidence

It is imperative for the successful application of the most serious sanction, i.e.
criminal proceedings, that all evidence is gathered, recorded and controlled only by
an accredited Local Counter Fraud Specialist. This does not preclude any member of
NHS Norfolk from innocently or professionally receiving evidence from another or
from the general work environment, but once a single piece of evidence is received,
then the counter fraud specialist must be informed immediately without any further
actions being taken.

3.2.2 Alerting Suspects

It is essential that those further criminal evidence and may also result in a dissipation
of personal assets, which may be subject to injunctive relief without notice to the
fraudster.
The general rule therefore, is that no steps should be taken to unilaterally seek to
apply a sanction or to impose a suspension until the Local Counter Fraud Specialist
completes the investigation. It is accepted that in exceptional circumstances such
actions may be taken:

• With the agreement of the Local Counter Fraud Specialist; and

• Where not to take such action might prejudice patient care or involve further
extensive losses to NHS Norfolk’s funds.

Policy for the Application of Sanctions       5 of 7           Version: 1 December 2009
In Respect of Fraud and Corruption
NHS Norfolk
3.3 Progression of Actions

        3.3.1 All allegations of fraud must be reported immediately to the Local
        Counter Fraud Specialist.

        3.3.2 All investigative tactics will be determine by the Local Counter Fraud
        Specialist.

        3.3.3 Any initial evidence must be handed over to the Local Counter Fraud
        Specialist immediately.

        3.3.4 Under no circumstances must the suspect be advised that an
        investigation is underway or likely to be investigated.

        3.3.5 Under no circumstances must a suspect be interviewed by any member
        of staff, other that the Local Counter Fraud Specialist.

        3.3.6 After an initial review of any allegation and/or receipt of evidence, the
        Local Counter Fraud Specialist will immediately liaise with the Director of
        Finance and the Director of Human Resources to:

        • Consider the evidence to hand
        • Determine the seriousness of the fraud
        • Determine the scope, scale and resources for the continuation of an
        investigation
        • Consider employment and disciplinary factors

        3.3.7 The Local Counter Fraud Specialist will remain in constant liaison with
        the Director of Human Resources in the event that disciplinary proceedings
        are accepted as urgent.

        • The Director of Finance will determine, as advised by the Local Counter
        Fraud Specialist, what evidence (and in what form) can be released for the
        purposes of disciplinary proceedings.

        3.3.8 The Local Counter Fraud Specialist will remain in constant liaison with
        the Director of Finance in the event that criminal and/or civil proceedings are
        necessary:

        • The Director of Finance will determine, as advised by the Local Counter
        Fraud Specialist, whether or not to pursue criminal proceedings.

        • The Director of Finance will determine, as advised by the Local Counter
        Fraud Specialist, whether or not to pursue civil proceedings for the recovery
        of all losses identified.

        3.3.9 All decisions reached at every stage, will be recorded and retained in
        both the Fraud Register and relevant case file held by the Local Counter
        Fraud Specialist on NHS Norfolk’s behalf, which will afford complete
        transparency and demonstrate NHS Norfolk’s consistent and equitable
        approach to sanctions and redress for inspection purposes by the Counter
        Fraud and Security Management Services. All referrals / allegations are



Policy for the Application of Sanctions     6 of 7           Version: 1 December 2009
In Respect of Fraud and Corruption
NHS Norfolk
        reported periodically to the Audit Committee and uploaded onto the NHS
        CFSMS Case Management System / First (CMS) as and when received.


4 Professional and Ethical Considerations

4.1 A maxim of English Law is that a person is innocent until found guilty in a court of
law. All criminal investigations will be conducted with due respect of the maxim and
evidence will not be sought to prove a fraud, but will be gathered as facts in order to
obtain the truth. The sanction of criminal proceedings will be pursued solely on
professionally gathered facts.

4.2 For criminal proceedings, NHS Norfolk will be advised by the Police, Crown
Prosecution Services, Regional CFS and SOL P as to whether the facts warrant a
case to be brought by the Crown against a suspect/s.

4.3 The burden of proof in respect of civil proceedings is on the balance of probability
and therefore it will be for the Director of Finance, as advised by the Local Counter
Fraud Specialist and civil litigation experts (Capsticks), as to whether or not a
pleading is made for recovery.

4.4 It is the policy of NHS Norfolk that on every occasion that a fraudulent act is
identified that the disciplinary process will be invoked.

4.5 It is the policy of NHS Norfolk that every employee subject to allegations or
suspicions will be treated fairly with due regard for Human Rights, as enshrined in the
European Human Rights Charter. Every individual case will be treated consistently
regardless of age, gender, ethnicity or position of person employed.


5 Summary

It is the policy of NHS Norfolk that all employees should know that NHS Norfolk is
determined to protect itself against those who would deny the public the highest
standard of care possible by acts of fraud. Those who would commit fraud should
know that it is not just criminal prosecution which they may face, but the use of civil
law so that they do not profit from their fraud and the disciplinary process to remove
them from the context in which their fraud took place.


6 Local Counter Fraud Specialist Contact Details

This policy will be held on the ‘counter fraud page ‘ of the staff intranet for all staff to
view.

Your Local Counter Fraud Specialist is: Stevan Burtenshaw and can be contacted
by the following means:

Tel: 01603 421421 (Ext: 8065)

Email: stevan.burtenshaw@nwmhp.nhs.uk or
      stevan.burtenshaw@nhs.net


Policy for the Application of Sanctions        7 of 7            Version: 1 December 2009
In Respect of Fraud and Corruption
NHS Norfolk

				
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Description: Agenda item134 SUBJECT Policy for the application of sanctions