Focus on fraud

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With an annual budget of around £110bn, the National Health Service has been seen by some as a target for fraud. Now, it seems that the NHS is becoming more aware than ever of this. It is keen to develop an anti-fraud culture in response to the recognition that fraud accounts for 3 per cent of its expenditure - roughly £3.3bn. Much of this fraud awareness has seen the NHS taking a particularly close interest in areas involving high-volume, low-value activities that are carried out regularly. Activities such as those that involve the likes of optical practitioners, GPs and dentists, who carry out work and bill the NHS accordingly.

You probably don't need me to tell you that there have been fraud cases involving such professionals. At Rahman Ravelli, we have been involved in a number of such cases. Thankfully, we have been able to establish our clients' innocence. This was possible because we could support our legal arguments with solid, documentary evidence and testimony. With this in mind, optical practices have to remember some essential points when carrying out their day-to-day duties. Even the most honest opticians now have to be careful about how they run their practices if they are to avoid investigation. With all aspects of the NHS under scrutiny, being innocent is something that has to be backed up with clear evidence whenever the question of fraud arises.

The optical profession has certainly done much to promote integrity in its ranks and encourage a culture of sound professionalism. But there have still been cases in the media of opticians acting fraudulently. Some have come to light after concerns were voiced by patients or colleagues while others were detected by the NHS Counter Fraud Service. Any such allegation - whether based in truth or not - can lead to an optical practice and related properties being raided. Keeping the practice running becomes extremely difficult when faced with an investigation and the damage it can do to an optician's reputation.

In such circumstances, being able to challenge the allegations effectively and quickly is vital. But this can only be achieved if an anti-fraud culture already exists in the practice. It is important, therefore, that optical practices take action that will make it easier to rebut any fraud allegations in the future - and reduce the scope for any fraud to have been carried out in the first place.

Record-keeping is the first key point in defending against fraud. Comprehensive records of work booked in, performed and billed for must be kept contemporaneously. There can be no lag in completing the paperwork and all such records must be kept in duplicate and filed away. Pre-empting any investigation and the questions that are likely to follow will be far easier if the practice has easy access to an up-to-date, accurate and contemporaneous record-keeping system.

Anti-fraud systems

Secondly, the practice has to be proactive and look at the potential for fraud in the way it operates. This is important whether or not the people running the practice believe or suspect that fraud is being carried out. All aspects of the way the practice operates should be examined closely. Clear operating procedures should not only be in place. They should be regularly reviewed, revised where necessary and publicised to all staff within the practice. It may be worth bringing in legal experts in the field of compliance. They can help the practice ensure it functions in a way that shows clearly to anyone that it offers absolutely no potential for fraud.

To the cynic, or even an extremely busy practitioner, this may seem like an unwanted expense and an unnecessary use of time. But if it helps prevent fraud in the practice (and ensures that it can be proved there isn't any, should investigators come calling) then it can only be seen as a worthwhile investment. If the alternative is fraud - or even merely an allegation of fraud - that leads to an investigation, reputational damage and financial harm to the business, then surely a proactive approach can be seen as a worthwhile investment.

In the serious world of fraud investigations, being too busy to notice fraud in your practice is no defence. Mistakes can be made - and we have been able to argue successfully to the courts that they were made innocently - but failing to introduce any form of anti-fraud culture in a practice will gain no sympathy from prosecutors.

Fraud in the optical world may never be totally eradicated. There is always the potential for it somewhere within the patient/practitioner/NHS arrangement that exists. It could even be carried out by an optical professional or staff unknowingly if records and payments are not organised as meticulously as they should be. But practices can, with a little forethought and the right legal help, ensure that both the potential for fraud and their liability for it are minimised.

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Aziz Rahman

is founder of Rahman Ravelli Solicitors, specialists in fraud and business crime. www.rahmanravelli.co.uk