Fraud Control Framework, April 2012 - Ambulance Service of NSW

74 Pages·2012·0.87 MB·English

Standard Operating Policy
FRAUD CONTROL FRAMEWORK IN AMBULANCE SOP
Document No. SOP2012-007
File No. 12/114 (D12/4851)
Date issued 11 April 2012
Contents Policy Statement Fraud Control Framework in Ambulance
Attachments 1. Fraud Control Framework – Ambulance Service of NSW –
Version 2012/01
2. Attachment 1 – Fraud Control Work Plan – 2012/12 –
Ambulance Service of NSW – Version 2011/06
3. Fraud Risk Assessment 2010-2012
Author Branch Professional Standards and Conduct Unit
Branch Contact [phone]
Division Professional Standards and Conduct Unit
Summary The purpose of this policy is to provide staff with information as to how fraud control is
managed within Ambulance.
Applies to All Ambulance Service of NSW staff
All Operational staff
All Administration staff
All Headquarters staff
Division staff (Aero Medical, Metropolitan and Regional)
Operation Centres
Review Date 1 November 2013
Previous Reference 1. Ambulance Service of NSW – Fraud Policy
(Extracted and Modified from the NSW Health Website
http://www.health.nsw.gov.au/pubs/1997/pdf/annual_report_97.pdf)
NSW Health Annual Report 1996/97 – Appendix 28, pg. 146
(Excerpt from Circular 93/70 and PD2005_059)
2. Fraud Control Strategy – Department of Health NSW – PD2007_070
Status Active
Approved by Chief Executive
Related Documents • NSW Health Policy Directive – PD2007_070 Fraud Control Strategy
• SOP2007-012 Code of Conduct

Revision History
Version (Circular) Amendment notes
11 April 2012 Fraud Control Framework and Fraud Control Work Plan approved by Audit and Risk
(SOP2012-007) Committee and A/Chief Executive.
25 January 2012 SOP covering Fraud Control Framework and Fraud Control Work Plan approved by the
(SOP2012-001) A/Chief Executive.
SOP2012–007 Page 1 of 3
Standard Operating Policy
Revision History – continued

Version (Circular) Amendment notes
16 December 2005 Fraud Policy
(IC05/30) (Extracted and Modified from the NSW Health Website)
1996/97 http://www.health.nsw.gov.au/pubs/a/ar9697/a2800.html)
NSW Health Annual Report 1996/97 – Appendix 28
(excerpt from Circular 93/70 and PD2005_059)
Compliance with this policy directive is mandatory

SOP2012–007 Page 2 of 3
Standard Operating Policy
Fraud Control Framework in Ambulance Policy Statement
Statement of Attitude to Fraud
Ambulance has a zero tolerance approach to fraud.
Fraud Control in Ambulance
Ambulance has established a Fraud Control Framework which underpins the Ambulance Fraud Control Work Plan. All
employees are to comply with the guidance provided under the Fraud Control Framework.

The Fraud Control Framework is consistent with the Ambulance Code of Conduct.

The Ambulance Fraud Control Work Plan outlines specific program risks which have been identified in the bi-annual risk
assessment. Program Managers are required to maintain an awareness of and implement specific risk management
strategies covered in the work plan which relate to their program areas.
Definition of fraud
For the purposes of this SOP, fraud is defined as any false representation or concealment of fact with the necessary
criminal intent to permanently deprive someone or to induce someone to part with something of value. Benefits that are
obtained by deception or other means can be either tangible or intangible.
Responsibilities of Staff in Fraud Control
Responsibility for fraud control includes prevention, detection, deterrence and response and is a shared responsibility
across all levels of the Service.

The Chief Executive has overall responsibility for ensuring that the strategic aims of the Fraud Control Framework and
Work Plan are complied with across Ambulance. Director/s Operations/Corporate and General Managers have delegated
responsibility to ensure that allocated elements of the plans risk assessment are managed and reported upon as
required.

The Chief Finance Officer, Director, Professional Standards and Conduct Unit and Manager, Risk Management
have responsibility to conduct two yearly reviews of the Ambulance Risk Management Assessment and Fraud Control
Work Plan. The review of the planning documents should also be undertaken when any new function/service or major
structural change occurs within Ambulance.

All employees have a responsibility to report suspected incidents of fraud to either the Chief Executive, Director,
Professional Standards and Conduct Unit, Director, Operations/Corporate, Chief Finance Officer or General Managers as
appropriate.

All employees of Ambulance have a responsibility to comply with the risk management strategies that are applicable to
their respective work place environments or level of decision making as outlined in the Fraud Control Framework and
Fraud Control Work Plan.

All employees have a responsibility to comply with the Code of Conduct and Organisational Values. Employees may be
called to account for their actions or non-action in compliance with that code.

Note: Failure of an employee to take reasonable action to report suspected fraud may amount to misconduct and may be
dealt with in accordance with the Health Services Regulation 2008 and supporting Ambulance Procedural Guidelines for
Dealing with Misconduct.
Review of the Fraud Control Work Plan
The Plan will be reviewed every two years on completion of the Risk Management Assessment review.

SOP2012– 007 Page 3 of 3
FRAUD CONTROL FRAMEWORK

AMBULANCE SERVICE OF NSW

VERSION 2012/01

Hierarchy of review Delegated officer Date

Version (1) 2011/01 - 24/05/11 Stephen Murphy, Investigation 25/5/11
Officer, Professional Standards &
Conduct Unit (PSCU)

Version (2) 2011/02 - 02/06/11 Incorporating comments by Director 30/05/11
PSCU – Ms Marian O’Connell (MOC)

Version (3) 2011/03 – 24/06/11 Incorporating comments by Director 24/6/11
Executive Support Joanna Clark
Incorp changes by MOC

Version (4) Incorp changes by Chief Finance 12/10/11
Officer (CFO)

Version (5) 12/10/11 Incorp changes by CFO and General 04/11/11
Manager (GM), Corporate Services

Review – Director PSCU Marian O’Connell 18/10/11

Review – CFO Stephen O’Malley 18/10/11

Review – Risk Management Natasha Hallifax

Review - GM, Corporate Services Michael Landsbergen 19/10/11

Approval - Chief Executive (CE) Mike Willis 19/12/11

Endorsement Audit and Risk 19/3/12
Management Committee
Version 2012/01

1
Table of Contents

Pg
1. BACKGROUND TO THE AMBULANCE SERVICE OF NSW 3
1.1 Statement of Attitude to Fraud 3

2. WHY FRAUD CONTROL? 4
2.1 Definition of fraud 4
2.2 Definition of Corruption 5

3. RESPONSIBILITIES OF STAFF IN FRAUD CONTROL 5
3.1 The Chief Executive 5
3.2 The Chief Finance Officer (CFO), Director, Professional Standards and Conduct Unit 5
(PSCU) and Manager, Risk Management
3.3 Management 6
3.4 All employees 6
3.5 Fraud Control Responsibility – Implementation 6

4. FRAUD RISK ASSESSMENT 7
4.1 Qualitative Risk Analysis Matrix Utilised 7

5. FRAUD RISK MANAGMENT 7
5.1 Managing Fraud Risk associated with outsource functions/consultancies/contractors 7

6. FRAUD INVESTIGATION CASE REFERRAL STANDARDS AND TRAINING 7
6.1 Fraud Awareness Training 7
6.2 Fraud Control Work Plan Training 8
6.3 Prosecution of Fraud 8
6.4 Reporting of Corruption or Maladministration 8
6.5 Fraud Investigation Standards 8

7. RELATIONSHIP WITH OTHER AMBULANCE PLANS 8
7.1 Corporate Plan 8
7.2 Strategic and Annual Internal Audit Plans 8

8. REVIEW OF THE FRAUD CONTROL WORK PLAN 9

Attachments

Pg
1 Fraud Control Work Plan - Ambulance 10
2 Fraud Control Strategy – Ministry of Health PD2007_070
3 Fraud Risk Management Assessment 2010-12
4 Ambulance Code of Conduct
5 Ambulance Service Values Chart

Ambulance Service of NSW – Fraud Control Framework - p2
1. BACKGROUND TO THE AMBULANCE SERVICE OF NSW

The Ambulance Service is committed to providing high quality clinical care and health
related transport services to the people of NSW.

In the 2010/11 year, the Ambulance responded to 1149820 emergency and non-emergency
incidents requiring Ambulance response. For the same period 837070 Emergency Triple
Zero calls were also managed.

The Ambulance employs over 4 300 people, with 90% being operational staff involved in
the front line delivery of services. This includes Paramedics, Patient Transport Officers and
specialised areas such as Intensive Care and Extended Care Paramedics, Special
Operations, Counter Disaster, Aero Medical and Medical Retrieval. The remaining 10% of
the workforce are corporate, clinical and other support staff that assist in the delivery of
services.

1.1 Statement of Attitude to Fraud

Ambulance has a zero tolerance approach to fraud

Fraud damages the reputation of Ambulance in the wider community and impacts
negatively on the resources available to promote and deliver Ambulance objectives.
Ambulance is committed to minimising the incidence of fraud through the
identification of risks and the development, implementation and regular review of a
range of fraud prevention and detection strategies.

Where there is substantial change in the structure or functions of Ambulance, or a
transfer of functions (such as the result of outsourcing), Ambulance will undertake to
reassess fraud risk by undertaking a Fraud Risk Management Assessment
specifically in relation to the change and update the Fraud Control Work Plan
accordingly.

Each fraud prevention and detection strategy is designed to contribute to an
environment based upon risk management, sound internal controls, monitoring and
improvement to systems and proper ethical practices. Specifically they cover
monitoring of the effective controls and new initiatives for high residual risk events.

To achieve this Ambulance:
• reviews its Fraud Risk Management Assessment every two years and
updates its Fraud Control Work Plan
• encourages and promotes professional and ethical business practice by staff
and external service providers
• clearly defines the hierarchical reporting and decision making process with
respect to suspected instances of fraud
• uses all available avenues to recover money or property lost through
fraudulent activity
• where appropriate, prosecutes persons and/or organisations for fraud
offences, should they occur
• implements arrangements for the provision of information, to the
Professional Standards and Conduct Unit (PSCU) on all suspicions of/or a
prima-facie case of fraud
• provides assurance to the probable identification of fraud through regular
reviews and scrutiny of operations

Ambulance Service of NSW – Fraud Control Framework - p3
To achieve this through its employees Ambulance:
• facilitates fraud awareness training for all employees
 trains selected employees in initial investigation techniques, including the
recognition of fraud risk indicators and how they can implement measures
and procedures to assist in the detection of fraud
 clearly articulates standards and procedures to encourage the minimisation
and deterrence of fraud

2. WHY FRAUD CONTROL?

Fraud and corruption risks exist within all NSW Government Agencies. Fraud risk, as a
category of corporate risk, presents any organisation with the greatest threat in respect to
financial loss and damage to reputation.

The nature of fraud and corruption means they are pervasive risks which constantly change
and require ongoing monitoring. For these reasons, the NSW Independent Commission
Against Corruption (ICAC) and Audit Office of NSW both recommend agencies assess their
fraud and corruption risks on a regular basis, and ensure that steps are taken to effectively
manage and prevent fraud and corruption from occurring.

Ambulance has a requirement and a commitment to actively support the NSW Ministry of
Health’s Fraud Control Policy – PD2007_070 (Attachment 1).

This Fraud Control Framework and Work Plan provides for an effective tool to ensure that
Ambulance meets its compliance obligations to the NSW Ministry of Health and relevant
Health Policy in the areas of fraud control.

The platforms of an effective fraud and corruption control framework are deterrence through
strategies that manage:
• Prevention
• Detection and
• Investigation.

This Fraud Control Framework and Work Plan and the supporting risk assessment are key
components of the fraud prevention and detection strategies that will be adopted by
Ambulance.

Fraud awareness training and an investigative response capability are key components of
the fraud deterrence strategy.

2.1 Definition of fraud

For the purposes of this plan, fraud is defined as any false representation or
concealment of fact with the necessary criminal intent to permanently deprive
someone or to induce someone to part with something of value.

The definition includes events or incidents involving:
• theft
• obtaining property, financial advantage or any other benefit by deception
• causing a loss, or avoiding or creating a liability by deception
• providing false or misleading information to the Ambulance, or failing to
provide information where there is an obligation to do so
• making, using or possessing forged or falsified documents
• bribery, corruption, abuse of office or maladministration
Ambulance Service of NSW – Fraud Control Framework - p4
• unlawful use of Ambulance computers, vehicles, telephones and other
property or services
• any offence of a like nature to those listed above.

Benefits that are obtained by deception or other means can be either tangible or
intangible. Some examples include:
• hacking into or interfering with an Ambulance computer system
• using Ambulance systems to gain access to other systems without authority
• charging Ambulance for goods or services that are incomplete or not
delivered
• making false/fraudulent statements of claim against advertised positions

2.2 Definition of Corruption

Corrupt conduct is defined under the Independent Commission against Corruption
Act 1988 as the dishonest or partial exercise of public official functions. It may also
involve the conduct of non-public officials which adversely affects the honest and
impartial exercise of a public official’s functions.

Public officials include people working in government departments, statutory
authorities and local councils in NSW, as well as judges and magistrates and
elected officials.

For conduct to be considered corrupt under the ICAC Act definition it has to be
serious enough to involve a criminal or disciplinary offence or be grounds for
dismissal. However, at the point a report is made to ICAC, the reporting officer need
not know with any certainty that this seriousness test can be satisfied as this will
often only be known after a full investigation.

Some examples of corrupt conduct by public officials that fall within this definition
include:
• A company wants to do business with the government and pays a public
official to choose that company for the job
• A public official bypasses recruitment procedures to employ friends or family
members
• A public official accesses confidential information as a favour to a friend
• A public official takes office petty cash to pay for personal items
• A public official extorts money from a client in their care
• A public official uses a work computer and e-mail address to run a private
internet business

3. RESPONSIBILITIES OF STAFF IN FRAUD CONTROL

Responsibility for fraud and corruption control which includes prevention, detection,
deterrence and response is a shared responsibility across all levels of Ambulance.

3.1 The Chief Executive has overall responsibility for ensuring that the strategic aims
of the Fraud Control Framework and Work Plan are complied with across
Ambulance Operational and Corporate. Director/s and General Managers have
delegated responsibility to ensure that allocated elements of the plans risk
assessment are managed and reported upon as required.

3.2 The Chief Finance Officer, Director, PSCU, Manager, Risk Management have
responsibility to conduct two yearly reviews of the Ambulances Risk Management
Assessment and Fraud Control Work Plan.
Ambulance Service of NSW – Fraud Control Framework - p5
The review of the planning documents should also be undertaken when any new
function/service or major structural change occurs within the organisation.

3.3 All employees have a responsibility to report suspected incidents of
fraud/corruption to either the Chief Executive, Director, PSCU, Operational /
Corporate Directors or General Managers as appropriate.

3.4 All employees have a responsibility to comply with the risk management strategies
that are applicable to their respective work place environments or level of decision
making.

All employees have a responsibility to comply with the Code of Conduct and
Ambulance Service Values. Employees may be called to account for their actions or
non-action in compliance with that code.

Note: Failure of an employee to take reasonable action to report suspected fraud/corruption
may amount to misconduct and may be dealt with in accordance with the Health Services
Regulation 2008 and supporting Procedural Guidelines for Dealing with Misconduct.

3.5 Fraud Control Responsibility – Implementation

Responsibility Responsible Officer/Area Finish date

Overall responsibility for ensuring • Chief Executive Ongoing
compliance with the Fraud Control
Framework and Work Plan.

Coordinating the conduct of a risk • Chief Finance Officer Ongoing
assessment to ensure the ultimate • Director PSCU
delivery of a Fraud Control Work Plan • Manager, Risk Management
every two years.

Providing a central reporting point for • Director PSCU Ongoing
allegations of incidents of fraud,
ensuring that matters are
appropriately recorded, investigated,
referred (when and where
appropriate) and reported.

Coordination of training, including • Director PSCU Ongoing
fraud awareness training.

Prevention and detection of fraud • All Ambulance program Ongoing
within program areas through the areas
strategic implementation of the
internal control system and any other
effective means.

Assisting with implementation of the • All staff Ongoing
Fraud Control Framework and Work
Plan.

Ambulance Service of NSW – Fraud Control Framework - p6
4. FRAUD RISK ASSESSMENT

Ambulance managers are responsible and accountable for understanding the potential risk
areas that relate to their areas/program responsibilities. The Fraud Risk Management
Assessment is a key document to aid managers in gaining an understanding of the range of
fraud risk categories that the Ambulance is exposed to (Attachment 3).

4.1 Qualitative Risk Analysis Matrix Utilised

The Fraud Risk Management Assessment has been developed in accordance with
Australian/New Zealand Risk Management Standard 4360. Fraud risk identified as
part of the preparation of this assessment have been categorised as high, medium
or low in accordance with the following Qualitative Risk Analysis Matrix:

CONSEQUENCE
LIKELIHOOD Insignificant Minor Moderate Major Severe
Rare Low Low Medium Medium High
Unlikely Low Medium Medium Medium High
Possible Low Medium Medium High Extreme
Likely Medium Medium High High Extreme
Almost Certain Medium High High Extreme Extreme

5. FRAUD RISK MANAGMENT

5.1 Managing Fraud Risk associated with outsource functions / consultancies /
contractors

Ambulance may use external service providers to enhance service delivery
functions. To ensure the risk of fraud and corruption associated with external
service providers is managed, when selecting service providers Ambulance
provides assurance that the following issues are considered:
• the necessity for the service provider to meet and comply with procurement
guidelines that may be instigated by Ambulance
• he depth of experience of the service provider including the outcomes of
past work
• the solvency of the external service provider
• the potential for conflict of interest where the external provider is a client or
provides other services to Ambulance
• the commitment of the service provider to comply with Information Privacy
Principles as outlined in relevant Health policies, Acts or Regulations
• the need to meet the relevant levels of competency

6. FRAUD INVESTIGATION CASE REFERRAL STANDARDS AND TRAINING

6.1 Fraud Awareness Training

Ambulance recognises that the primary purpose of education and training in the
area of fraud control is it to contribute to the prevention and control of fraud by
raising the level of awareness amongst staff. The objective is to aid staff in
identifying fraudulent practices and to make it very clear that such practices will not
be tolerated by the Ambulance.

Fraud awareness training will be incorporated into the Code of Conduct Training
delivered to employees by the Professional Standards and Conduct Unit.
Ambulance Service of NSW – Fraud Control Framework - p7