Protecting Your Care Service: Spot, Prevent and Act on Fraud, What Providers Must Do Now

 

 

Fraud and financial abuse are real threats to adult social care providers. As regulators tighten oversight and new legislation comes into force, every care provider, large or small, needs robust processes to protect people, providers, and public trust.

Below, we outline key lessons and steps from our recent webinar, along with frequently asked questions from providers. Use this article as a checklist and starting point for strengthening your system against fraud risk.

Why Fraud Prevention Matters in Adult Social Care

• The risk of financial abuse and fraud in care settings is well documented, residents with care needs are often vulnerable, and misuse of funds, mis-representation or improper billing can harm both individuals and organisations. lancashiresafeguarding.org.uk+2Newcastle Safeguarding+2
• Legally, providers now need to implement what the law calls “reasonable prevention procedures”; under recent legislation (e.g., the Economic Crime and Corporate Transparency Act 2023), lack of adequate fraud prevention can expose organisations to criminal risk. skadden.com+1
• As a care provider, you have an ethical, and legal, duty under the Care Quality Commission (CQC) regulations to safeguard people from abuse, including financial abuse. Care Quality Commission+1

Given these pressures, regulatory, legal, reputational, fraud prevention should be viewed as a core element of quality, not an optional extra.

What Care England Members Told Us: Common Pressure Points

During our recent webinar and Q&A with care providers we heard:

• Providers often lack formal fraud risk assessments or documented counter-fraud policies.
• Staff turnover, reliance on agency workers, and high administrative burden can increase vulnerability.
• Many providers are uncertain how to spot “hidden” fraud, billing irregularities, forged timesheets, inconsistent payroll or receipts.
• Some providers worry they lack the capacity or know-how to investigate suspicions effectively.

These concerns reflect what independent toolkits also highlight as red flags in adult social care settings. cifas.org.uk+1

Practical Steps: How to Protect Your Service

Based on best practice and guidance, every care provider should consider:

1. Conduct a fraud-risk assessment
   • Identify highest-risk areas (payroll, procurement, direct payments, agency usage). GOV.UK+1
2. Adopt clear anti-fraud and financial-abuse policies
   • Define roles, responsibilities, reporting processes, whistle-blower channels.
   • Ensure senior management sets the tone, fraud prevention must come from the top. skadden.com+1
3. Train all staff and agency workers on recognising and reporting fraud or financial abuse
   • Awareness helps spot unusual patterns early, especially in environments with vulnerable adults. cifas.org.uk+1
4. Maintain transparent financial and audit trails
   • Ensure all payments, invoices, and receipts are logged, checked, and securely stored.
   • Review and reconcile financial records regularly.
5. Implement a regular review process and internal governance
   • Schedule periodic audits of high-risk functions.
   • Establish clear escalation and response protocols if suspected fraud arises.
6. Engage with safeguarding procedures and regulators where needed
   • Where financial abuse or fraud is suspected, follow CQC and safeguarding guidance. Care Quality Commission+1

Questions from Providers, and Straight Answers

Question	Answer / What to Do
What must a “reasonable fraud prevention procedure” look like?	It must include top-level commitment, a documented risk assessment, proportionate procedures, due diligence on staff/contractors, training, monitoring and review. skadden.com+1
Does every small provider need a full fraud team?	No, but you must have clear governance, defined roles for who reports, simple checks (e.g. audit trails, reconciliations), and a “speak-up” culture.
What if we suspect financial abuse by a staff member?	Follow your safeguarding policies, record all evidence, and report under your duty of care. Fraud or abuse against vulnerable adults is a serious safeguarding concern. lancashiresafeguarding.org.uk+1
How often should we review financial controls?	At least annually, but more frequently if your service or staffing is large, or if you use agency / temporary staff. Regular reviews help catch “small leaks” before they become big losses.
Is it enough to rely on invoices and receipts?	Documentation is essential, but not enough. Providers should verify service delivery, staff payroll consistency, and safeguard directly if care or funds are managed for individuals.

Next Steps for Care England Members

• Use the article above as a checklist to review your internal policies and procedures.
• Share it with your management team and board to ensure senior buy-in.
• If your service does not yet have a fraud-prevention or financial-abuse policy, now is the time to create one.
• Consider free external resources and toolkits, such as the Cifas Adult Social Care Fraud Toolkit, to strengthen your approach. cifas.org.uk+1
• Bookmark the recording of our webinar (link below) so you can refresh staff training and awareness when needed.

 

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Webinar Recording & Further Reading

Watch the full webinar:

Review the Virgin Money Fraud-Prevention information designed to help care providers stay safe:

https://uk.virginmoney.com/business/fraud-awareness/

 

Stay alert, stay safe, and protect both your service and the people you support.