Adult social care fraud is thought to be one of the highest risk areas of fraud, costing councils across the UK millions of pounds every year. According to CIPFA’s latest fraud and corruption tracker, social care fraud costs the public purse an estimated £13.7 million a year – with the average case worth £29k.
Knowledge of social care fraud is generally improving within the public sector and multiple high profile prosecutions across the UK have helped to raise awareness, but there is always more that can be done.
When someone requires care, the local authority has a duty to them. There are a lot of rules involved with eligibility criteria for social care funding. They can depend on the type of care someone receives and their current circumstances.
The amount of financial support a person may get is based on individual circumstances. The council will carry out a means-test called a financial assessment to work out how much people pay for care. Some people don’t have to pay anything because of the type of service they get, or because the financial assessment shows they can’t afford to.
Generally, most people will be required to pay something towards the cost of their care. Anyone with savings or assets over £23,250 isn’t entitled to any financial support. As with many areas of public funding, the schemes can be open to abuse.
Examples of adult social care fraud
Examples of adult social care fraud include:
- Exaggerating a disability or illness to receive more support
- Not declaring, or under declaring income, benefits, savings, or capital in financial assessments
- Using direct payments for non-care related expenditure
- Care providers claiming for hours of care which haven’t been provided
Financial abuse fraud in social care
This is the most common type of social care fraud. It makes up about half of all social care fraud cases. Financial abuse is where the person in care has their money stolen or misappropriated.
Sadly this is often committed by someone close to them, who might hold power of attorney or have access to their finances. When their funds have been abused, they're no longer able to pay for their care.
This means the council has to step in and foot the bill. Losses can be high in any single case, making the council as much of a victim as the person receiving the care.
Direct payment fraud
Direct payments are council funds given to people to buy their own care and support. This can give people more flexibility and control in how their assessed needs are met. For instance, people use direct payments to employ their own personal assistants.
In certain circumstances someone may be appointed or nominated to manage direct payments on behalf of the person needing care, which sometimes leaves the scheme open to abuse. Where funds are spent on things other than what's included in a care and support plan, this may constitute fraud.
Other examples of direct payment fraud include:
- Carers putting in false timesheets or expense claims to earn more wages from the payments than they should
- Claiming false or exaggerated care needs - if someone claims to have needs they do not, receives money to pay for care and keeps the money for themselves
- Creating a fictitious unregistered care provider
- Submitting false receipts as evidence of care expenses
- Using money from the council to pay for care for own personal use
- Using the direct payment account for money laundering
Undeclared or deprivation of capital fraud
Someone who has more than £23,250 of savings (including assets such as properties, excluding the property they are living in) is not entitled to local authority funding for their care. Sometimes people attempt to conceal their capital and hide additional money from financial assessors to obtain funding they are not entitled to. This is called undeclared capital, and if intentional is treated as fraud.
Deprivation of capital is where someone deliberately reduces their savings or gets rid of assets. If they know they will need care, and 'gift' their money or assets to family and friends in order to avoid paying for care, this is an offence as legislated for in the Care Act 2014.
Report suspected social care fraud
You can report your suspicions directly to us:
Complete our online form to report fraud
or
- Call the fraud hotline on 01432 260698
- Write to us at: Counter Fraud Department, Corporate Services, Plough Lane Offices, Hereford, HR4 0LE
Your referral will be taken in complete confidence and any personal information provided will be treated as strictly confidential.
Please provide us with as much detail as possible so that we can investigate the matter effectively. Where a referral does not provide us with enough detailed information about the matter, it may not be possible to investigate.
You can report fraud anonymously. However, in most cases it would help us if you leave your contact details, so that we can contact you for further information should we need it.
How we deal with fraud reports
We treat all reports of alleged fraud very seriously and they will be investigated by our Counter Fraud Service. What action we take will depend on the legislation relating to the service or area in which the fraud is committed.
Any individual who intentionally and dishonestly provides false information, may be investigated in line with the Fraud Act 2006 and other relevant legislation. We may also pursue prosecution under Section 222 of the Local Government Act 1972, or work alongside the Crown Prosecution Service (CPS).