Counter Fraud

Purposes for processing

NHS England has a team of Accredited Counter Fraud Specialists with responsibility for the prevention and detection of fraud, bribery and corruption against the organisation.  When allegations are made suggesting that NHS England has been the victim of an economic crime, the Counter Fraud Team will conduct an investigation.  This may involve; gathering evidence, obtaining witness statements and interviewing suspects.  If evidence of a crime is found, the suspect may face disciplinary proceedings, (including referral to professional body), civil sanctions, and/or criminal proceedings.

We work closely with the NHS Counter Fraud Authority, who has oversight of cases as they progress and in the case of prosecutions, act as a gateway for initial file submissions to the Crown Prosecution Service.

Perpetrators of economic crime against NHS England can be anyone associated with the Health Service, including:

  • patients,
  • employees,
  • primary care contractors, (GPs, dentists, opticians, pharmacists)

In order to establish if a criminal offence has occurred, NHS England may request access to personal data.  Primary care contractors are obliged under regulations to provide information to NHS England that is reasonably required in connection with their contract, such as counter fraud activities. Service Condition 24 of the NHS Standard Contract requires providers to allow Counter Fraud Specialists access to information that is relevant to the detection and investigation of cases of bribery, fraud or corruption.

Categories of personal data

In order to carry out our activities to prevent and detect economic crime we may process the following data:

  • Contact details such as names, addresses, telephone numbers
  • Emergency contact(s)
  • Education and training, incl. development reviews (appraisals)
  • Patient data, incl. GP, dental optical and pharmaceutical records
  • Offences (including alleged offences), criminal proceedings, outcomes and sentences
  • Employment details, (employment contract, salary, position etc.)
  • Information around travel and subsistence; expenses
  • Employment / identity records (including professional membership, qualifications, references and proof of identity and eligibility to work in the UK)
  • Bank details
  • Pay, benefits and Pension details (incl. National Insurance number)

Please note this list is not exhaustive and may change over time.

Categories of recipients

Details of cases are entered on to the National Counter Fraud Authority’s case management system.

The NHS England Counter Fraud Team may also work alongside Clinical Commissioning Groups and NHS Business Services Authority in the investigation and prevention of fraud, bribery and corruption.

When a case is submitted for prosecution, information including personal data is sent to the Crown Prosecution Service.

Legal basis for processing

For GDPR purposes NHS England’s lawful basis for processing is Article 6(1)(e) – ‘…task carried out in the public interest or in the exercise of official authority…’.  This applies to investigation by NHS England, and co-operation with the NHS Counter Fraud Authority, Clinical Commissioning Groups and NHS Business Services Authority.

For the processing of special categories data the basis is 9(2)(g) – ‘…substantial public interest…’. This is supported by Schedule 1 Part 2 paragraph 10 (preventing or detecting unlawful acts) and paragraph 14 (preventing fraud) of the Data Protection Act 2018.