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‘Direct Payment’ fraud highlights risk area for NHS and local authorities

Conditional discharge and order of £17,000 repayment after NHS local counter fraud investigation

The mother of a disabled woman has been found guilty of fraud against the NHS and a county council (at Gloucester Crown Court, Monday 14 May).

Sandra Reynolds, 67, of Kayte Lane, Bishops Cleeve, near Cheltenham, pleaded guilty to false accounting earlier the same day. She made a personal gain of £17,000 from the fraud.

Reynolds’ daughter has both learning and physical disabilities. A substantial ‘Direct Payment’, jointly funded by the NHS Gloucestershire Clinical Commissioning Group and Gloucestershire County Council, was granted annually to meet her multiple care needs.

As Trustee of this Direct Payment budget, Mrs Reynolds was responsible for administering it wisely on behalf of the service user, in accordance with clear rules.

However, a fraud investigation led by Gloucestershire NHS Counter Fraud Service revealed that Sandra Reynolds was diverting money from this Direct Payment fund into her own personal bank account. In addition, the hours worked by the service user’s sister as a personal carer had been inflated by Reynolds.

The hours supposedly worked by the sister were recorded, without her full knowledge, on monthly timesheets. The investigation, jointly commissioned by the two bodies who funded the direct payment, established that she could not possibly have worked these hours as a carer; firstly, because she had a full time job as a solicitor; and secondly, because she was out of the country on holiday at some of these times.

Sandra Reynolds was initially charged with a single indictment of fraud by false representation, for submitting the false timesheets over a six year period between 2008 and 2014.

The defendant was later charged, on 14th May 2018, with one count of false accounting, two counts of fraud (relating to the Department of Work and Pensions) plus the original charge of fraud by false representation. Reynolds pleaded guilty to false accounting and not guilty to the other three charges. The pleas were accepted, but the charges to which she pleaded not guilty will remain on file. She has been given a conditional discharge and must pay back the money defrauded within 14 days.

Lee Sheridan, Head of Gloucestershire NHS Counter Fraud Service, who led the investigation, said today:

“It gives us no pleasure to see the parent of a disabled NHS service user in court. However it is very important that vital financial support systems for service users and their families are not undermined by fraud. This case is a reminder that there is a fraud risk attached to all payment systems, including direct payments.

“Reynolds was in a significant position of trust as the main administrator of the Direct Payments.  As Trustee, Reynolds was responsible for ensuring that the Direct Payment was administered correctly and staff paid for hours they had worked.  Over a lengthy period, Reynolds abused her position and the delegated responsibilities of a Trustee.

“The Gloucestershire NHS Counter Fraud Service is working with all public bodies to protect the NHS against fraud.”

Sue Frith, interim CEO of the NHS Counter Fraud Authority, said today:

“It is sad this investigation was necessary, and sad that it was ultimately the service user who was deprived of the level of care that had been put in place and funded for her. But it serves as an excellent example of partnership working between an NHS body and another authority to tackle fraud. At the national level, we would like to commend this successful joint approach.

“There are systems in place to report fraud and we encourage any health worker or member of the public who suspects fraud against the NHS, to report their concerns to our Fraud and Corruption Reporting Line. Today’s outcome should help deter others who might contemplate diverting direct payments from their intended purpose, which is the care of NHS service users.”

Margaret Willcox, director of adult services at Gloucestershire County Council, said:

“We take crimes such as these very seriously. It is vital that money provided for the county’s most vulnerable people is used for what it is intended. Neither the county council nor the NHS will tolerate misuse of such funding and this should be a warning to anyone that fraud will not be tolerated in Gloucestershire.”

 

 

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