Fraud Investigation Process

John Armstrong, UK Department for Work and Pensions

Session 5, UK

WORKSHOP ON
REDUCING ERROR, FRAUD & CORRUPTION (EFC) IN SOCIAL
PROTECTION PROGRAMS
June 8-12, 2014, Opatija, Croatia
 Interventions

• Benefits Administration – the need to ask the right questions, challenge

where necessary and verify documents and information.

• Fraud and Error Prevention – A targeted approach to reviewing claims

using telephone interviews.

• Customer Compliance – Robust interviews in response to some

allegations, high risk cases, targeted reviews. Can be done by
telephone or home visit but mostly by office interview.

• Investigation – Response to allegations or data matching where the

case is likely to be serious enough to justify prosecution or penalty.
Evidence gathered using procedures set in law and presented to the
Courts.

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 Investigations

The aim of investigations is to uncover the full extent of the fraud

and to prosecute in the most serious cases.

Bigger overpayments
– bigger penalty
– more publicity
– more deterrent effect

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 All investigations begin with an allegation of
suspected benefit fraud or a data match
identifying a possible inconsistency which
are referred by:
National Benefit Fraud Hotline – 9.0%

Internet Hotline Referrals – 13.6%

The Public – 5.8%

Members of Staff – 19.8%

Data Matching Service

Pro-Active Work – 2.1%

Local Authorities – 7.8%

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 How Referrals Are Considered

• Which benefit is or was in payment?

• What is the suspected offence?
• Over what period of time has the offence occurred?
• Is the investigation likely to achieve:
– An end to the claimant’s benefit entitlement
– An overpayment of benefit
– A criminal penalty

• What intelligence can be gathered? What evidence can be gathered?

– Financial information
– Social media or internet
– Witness statement
– Employer information
– Closed Circuit Television available
– Auto Number Plate Recognition
(Many more sources)

Will there be a need to conduct surveillance?

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 The different types of investigations

The most common frauds occur as a result of:

• Failure to declare true financial circumstances 25.7% of investigations
– Employment (paid or unpaid, employed or self employed work), household
income of any kind, capital (including savings, properties owned,
investments), student status (including loans or grants), outgoings over
declared (including rent, childcare or nursery care).
• Failure to declare true social, personal or family circumstances 24.2% of
investigations
– Living with a partner as husband and wife, children leaving, dependants
dying
• Disability related fraud 3.7% of investigations
– Unreported improvement in mobility or diminished care needs (Disability
Living Allowance cases), unreported improved capacity to work (Incapacity
Benefit and Employment and Support Allowance cases)
• Identity or organised fraud 1.0% of investigations
– Applying for national insurance numbers, benefits, payments or other
financial advantage, using a false or hijacked identity and/or false identity
documents in support; forgery and counterfeiting, or an organised attack or
manipulation of the welfare payment system such as a cyber attack, internal
or contract fraud

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 Criminal Intelligence

• Nine Criminal Intelligence Units process requests for information from

investigators by using:
– Authorised Officer/Intelligence Gathering Officers
– Social Security Administration Act 1992 s109B
– Social Security Fraud Act (SSFA)2001

Banks Building Societies Insurance Companies

Sky/Digital/Cable Providers Internet Enquiries
Credit Reference Agencies Money Shops
Education Establishments Police
Employers Royal Mail
HM Revenue and Customs Student Loan Company
HM Prison Service Universities/Colleges
Identity and Passport Service Telecommunication
Utility Companies

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 Specialist Intelligence

• Specialist desks/teams include:

– Social Media/Internet
– Abroad Fraud
– National Identity Fraud
– Joint Intelligence (HMRC)
– Cyber Crime
– Bank Intelligence
– Disclosure team
– Criminal Analysts

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 Surveillance

• FES are bound by the Home Office code of practice for Covert Surveillance
and Property Interference
And
The Regulation of Investigatory Powers Act 2000

• Surveillance must only be used when all other lines of enquiry have been
explored and there is no other way to prove or disprove the allegation.

• FES have introduced a standard operation approach to surveillance to

ensure that it is only conducted when necessary and proportionate.

• Those deployed under the standard operation approach will be training by

and adopt the same surveillance tactics as the Police

Types of surveillance include:

Deployment of a Covert Vehicle
Directed Closed Circuit Television
Manned Static Surveillance
Mobile surveillance in vehicle, public transport or on foot

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 Equipment

• Various forms of concealed recording equipment are used to help the

evidence gathering process

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 LAWS WE ARE GUIDED BY

We must adhere to;

 Human Rights Act 1998

 Regulation of Investigatory Powers
Act 2000
 Police and Criminal Evidence Act
1984(PACE)
 Social Security Administration Act
1992
 Criminal Proceedings and
Investigation Act 1996
 Data Protection Act 1998
 Computer Misuse Act 1980
 Social Security Fraud Act 2001

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 Penalties

Once an investigation is complete and investigators have

identified a potential offence, they have discretion whether
to:

• Apply an Administrative Penalty under section 115A or

section 115B Social Security Administration Act 1992 see
Diversion from Prosecution.

• Refer the case to the Crown Prosecution Service for a

decision whether to prosecute.

• Disallow or reduce the defendant/suspect’s benefit for a

prescribed period under the Social Security Loss of Benefit
Regulations see Loss of Benefit following Conviction

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 Results

Number of Administrative Number of Number of Cases

Penalties Issued Prosecutions Closed by Fraud
Investigation
2012 – 2013 3,863 9,836 130,853
(including joint
investigations with
Local Authority)
2013 - 2014 1,501 10,800 119,320 (including
investigations with
Local Authority)

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 Way of Measuring Performance

2013/14 Totals

Average % Case
Overpayments Value of Prosecutions Outcomes % Value
per Person (£) Prosecution per Person Prosecuted Prosecuted VfM

Central England 10,388 12,727 0.62 64% 76% 7.83

London & HC 10,176 17,159 0.38 51% 64% 6.74

North East England 11,494 14,679 0.58 57% 74% 8.88

North West England 11,321 20,258 0.43 58% 76% 8.44

Scotland 10,582 14,772 0.56 67% 78% 7.99

Southern England 10,369 14,428 0.41 50% 57% 7.65

Wales 10,154 14,074 0.45 49% 62% 7.25

FES Sub Total 10,633 15,228 0.49 57% 70% 7.75

CCIS 1,608 10,685 0.05 55% 36% 0.96

National Total 9,854 15,182 0.45 57% 70% 5.62

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 LAWS WE USE TO PROSECUTE ARE:

• Where the defendant has provided false information or made false declarations or
representations in his claim for benefit, it is likely that the majority of prosecutions will be
brought under:
– section 111A(1)(a) SSAA 1992 - dishonestly making a false representation to obtain
benefit
– section 111A(1)(b) SSAA 1992 - dishonestly producing or furnishing false information or
documents to obtain benefit
– section 2 of the Fraud Act 2006 - dishonestly making a false representation with intent to
gain or cause loss

• Where the defendant has made an initial legitimate claim for benefit but then fails to report a
change which affects entitlement, it is likely that the majority of prosecutions will be brought
under:
– section 111A (1A) SSAA 1992 - dishonestly failing to notify a change in circumstances
affecting entitlement to benefit; or
– section 3 of the Fraud Act 2006 - fraud by failing to disclose information
–
• Where tax credit fraud is alleged, the majority of prosecutions will be brought under:
– section 35 of the Tax Credit Act 2002 - knowingly concerned in fraudulent activity
undertaken with a view to obtaining payments of tax credits; or
– section 2 or section 3 of the Fraud Act 2006

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 Why we use Crown Prosecution Service (CPS)

• The Specialist Fraud Division of the CPS prosecutes cases investigated

by the Department for Work and Pensions (DWP), Her Majesty's
Revenue and Customs (HMRC), the Department for the Environment,
Farming and Rural Affairs (DEFRA), the Medicines and Healthcare
Regulatory Agency (MHRA), the Department of Health (DoH) and some
Local Authorities.

• Most benefit fraud cases are prosecuted in mainstream magistrates'

courts by CPS prosecutors.

• The CPS can advise on any benefit fraud investigations in the same
way as they can advise the police.

• Benefit fraud is now seen to be taken seriously

theft is theft.

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 Evidential Test

Evidential Test
• Can the evidence be used in court?
– Prosecutors should consider whether there is any question over the
admissibility of certain evidence.
– The likelihood of that evidence being held as inadmissible by the court; and
– The importance of that evidence in relation to the evidence as a whole.
• Is the evidence reliable?
– Prosecutors should consider whether there are any reasons to question the
reliability of the evidence, including its accuracy or integrity.
• Is the evidence credible?
– Prosecutors should consider whether there are any reasons to doubt the
credibility of the evidence.

• Prosecutors need to decide if there is more than a reasonable chance of

securing a conviction.
• The Courts need to decide if the case has been proved beyond reasonable
doubt

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 Public Interest Test

• How serious is the offence committed?

– Length of time the offence was committed over
– Amount of the overpayment
– False from outset or
– Change of circumstances

• What is the level of culpability of the suspect?

• Was the suspect under the age of 18 at the time of the offence?

• Is prosecution a proportionate response?

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 DWP Fraud & Error Service

Answers

Questions

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