Signature fraud in the NHS: A growing concern
Signature fraud in the UK’s NHS is a pressing issue impacting the organisation’s financial integrity and patient trust. Involving falsified signatures on documents such as timesheets, prescriptions, and medical forms, signature fraud contributes significantly to the estimated £1.2 billion lost annually to fraud, bribery, and corruption within the NHS. This form of deception often entails misuse by employees or external contractors and suppliers, siphoning funds intended for patient care. The NHS Counter Fraud Authority (NHSCFA) leads efforts to detect and prevent fraud, including signature-related instances, which can span various fraud types, from payroll manipulation to falsified procurement records.
In this blog, we explore the main types of signature fraud in the NHS, the key factors that enable these fraudulent activities, best practices for prevention, and how advanced technologies like Cygnetise help in this effort.
Do you still manually manage your authorised signatories? Contact us to see how we can help you automate the process and reduce 95% of the time spent on managing authorised signatories and bank mandates.
Forms of signature fraud in the NHS
Several types of signature fraud occur within the NHS network. Timesheet fraud is a common variant, where staff manipulate their reported hours or falsify approval signatures to receive unwarranted pay. This type of fraud can be subtle, involving small changes that accumulate over time, making it difficult to detect without robust monitoring systems. Procurement-related signature fraud also poses a significant risk, as fraudulent signatures on purchase orders and contracts allow suppliers or internal stakeholders to divert funds through inflated prices or unauthorised goods and services.
Additionally, the pandemic era has heightened certain risks due to emergency procurement and recruitment measures, creating vulnerabilities. For example, mandate fraud, or payment diversion fraud, has risen as criminals exploit the increased urgency for medical supplies, redirecting NHS payments into fraudulent accounts through falsified authorisation signatures.
Common types of NHS signature fraud
Timesheet fraud: Employees falsify their working hours by forging signatures on timesheets to claim pay for hours not worked.
Procurement fraud: Unauthorised individuals forge signatures on procurement documents to approve the purchase of goods or services, often at inated prices.
Prescription fraud: Signatures of healthcare professionals are forged on prescription forms to illegally obtain medicines.
Expense reimbursement fraud: Employees submit fraudulent expense claims with forged signatures to receive unauthorised reimbursements.
Contractor fraud: Signatures are forged on contractor agreements or change orders to authorise additional payments or modify contract terms without proper approval.
Identity fraud: Fraudsters use forged signatures to create or alter patient records and other identity documents within the NHS system.
Payment diversion fraud: Also known as mandate fraud, where changes to payment instructions (like bank details) are authorised using forged signatures to divert funds.
Factors enabling NHS signature fraud
Several factors contribute to the prevalence of signature fraud in the NHS. One critical element is the sheer size and complexity of the NHS, which oversees numerous transactions and documentation processes, creating ample opportunities for fraud to slip through. Resource constraints and staff shortages can further hinder strict monitoring and validation, especially during periods of heightened demand, like the COVID-19 pandemic, which put immense strain on the system and increased fraud risk as traditional checks took a backseat.
Moreover, the dependency on manual processes in some NHS areas makes it easier for fraudsters to forge signatures without being detected promptly. Digitalisation in areas such as electronic prescriptions and electronic patient records has begun to reduce risks by enhancing traceability and accountability, yet implementation is not uniform across the board. In regions where manual records still dominate, the risk of signature fraud remains elevated.
Prevention and detection measures
To tackle fraud, the NHSCFA has implemented several strategies, including dedicated anti-fraud standards and routine audits. One such preventive measure is the introduction of fraud reference guides and training programs to help employees recognise red flags and report suspicious activity. The NHSCFA also employs data analytics and forensic auditing techniques, leveraging technology to spot anomalies in financial transactions and document flows that may signal fraudulent activities.
As digitalisation advances, electronic signatures and robust digital record-keeping are becoming primary defence mechanisms. By employing secure electronic signatures, the NHS can reduce its reliance on physical signatures and increase the traceability of approvals. Additionally, a centralised reporting system and a 24-hour hotline managed by the NHSCFA allow staff to anonymously report suspected fraud, ensuring that incidents can be investigated promptly.
Legal and ethical implications
The legal ramifications of committing fraud against the NHS are severe, often involving criminal charges and disciplinary actions. Under the NHS Act, authorised officers are empowered to demand relevant documents from NHS staff and contractors suspected of fraudulent activities. Falsifying signatures, especially when it pertains to patient safety or misappropriation of funds, can result in criminal penalties, as highlighted by several high-profile cases where individuals faced suspension, fines, or even imprisonment for their actions.
Ethically, fraud undermines the foundational trust that the public places in the NHS. Every pound lost to fraud represents resources diverted from patient care, exacerbating challenges in delivering services and increasing wait times for vital treatments. Signature fraud, though sometimes perceived as minor, can compound financial strain on the NHS, ultimately impacting the quality of care patients receive.
Future directions in combating NHS fraud
The NHS aims to continue expanding its digital capabilities to minimise signature fraud, emphasising the adoption of electronic records and tighter access controls. Moving forward, the integration of biometric verification for electronic signatures and the deployment of artificial intelligence (AI) in fraud detection could further strengthen safeguards. These technologies can authenticate users and identify fraudulent patterns in real-time, significantly reducing the chances of undetected fraud.
Increasing collaboration with government bodies and private organisations will also be essential. For example, the NHSCFA collaborates with the Cabinet Office’s COVID-19 Counter Fraud Response Team, which guides the handling of fraud in emergency contexts. Public awareness campaigns and transparency initiatives are vital to encouraging vigilance within the NHS and the wider community, empowering both patients and staff to recognise and report suspicious activities.
Signature fraud: A growing threat in the NHS
How Cygnetise facilitates NHS fraud prevention
Cygnetise’s digital authorised signatory application offers a robust response to the issues of signature fraud in organisations like the NHS. By digitising the process of managing signatory rights, Cygnetise addresses fraud risks inherent in traditional, paper-based systems that rely on physical signatures. Our cutting-edge technology ensures that records are immutable and traceable, meaning any attempt to alter, forge, or misuse signatures by a non-authorised party is instantly detectable.
For the NHS, which oversees complex financial transactions and significant documentation involving employee and supplier signatures, Cygnetise can simplify and secure the process. Rather than relying on manual checks, and paper trails and forms, Cygnetise ensures all authorised signatories are recorded in a tamper-proof ledger. This makes it easier for administrators to update, verify, or revoke signatory rights, which is especially useful in high-turnover environments or when fraud risks are heightened.
Cygnetise also supports compliance with data protection and fraud prevention standards by providing a full audit trail of any signatory data changes made. In combination with the NHS Counter Fraud Authority’s initiatives, platforms like Cygnetise can modernise signatory management, streamlining processes and significantly cutting down opportunities for fraud.
By adopting Cygnetise or similar technology, the NHS could strengthen its commitment to secure, fraud-free operations, protecting its resources and ensuring they are used for their intended purpose: patient care.