Strategic Intelligence Assessment 2024

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Foreword

Alex Rothwell, Chief Executive Officer of the NHSCFA, introduces the 2024 Strategic Intelligence Assessment.

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Executive summary

A brief overview of the NHS’s overall vulnerability to fraud, bribery and corruption.

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Introduction

Why the NHSCFA produces an annual strategic intelligence assessment, and how the content should be interpreted.

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How do we calculate fraud vulnerability

Our approach to assessing how financially vulnerable the NHS is to fraud.

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Reporting trends

Levels of reporting received by the NHSCFA alleging fraud, bribery and corruption against the NHS in England compared to previous periods.

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Bribery and corruption

Fraud relating to dishonest or fraudulent behaviour by those in positions of power, typically involving bribery.

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Procurement and commissioning of services fraud

Fraud relating to pre-tender activity, the commissioning process, post-tender activity and mandate fraud.

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Patient exemption

Fraud within the main NHS services that require payment upfront in return for access. It also encompasses the onward sale or supply of prescribed medication.

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Data manipulation

Fraud through falsifying data to meet targets, increase revenue or hide undesirable outcomes.

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Community pharmaceutical contractor

Fraud relating to the falsification or exaggeration of services, as well as collusion.

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General Practice (GP) contractor fraud

Fraud relating to the manipulation of income streams or activities that violate contractual terms perpetrated by either GPs or practice staff.

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Optical contractor fraud

Fraud relating to submitting inappropriate claims to the NHS for optical treatments, services, or enhancements not delivered or clinically required.

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Dental contractor fraud

Fraudulent claims submitted to the NHS by dentists and their staff members for a range of NHS services provided to patients.

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NHS staff fraud

Fraud relating to members of NHS staff who fraudulently inflate or falsify their income, expenses or working hours for financial gain, or who assume a false identity.

Fraudulent access to NHS care from overseas visitors

When a patient falsely represents themself as entitled to NHS care without charge, fails to disclose they are chargeable, or an NHS staff member has abused their position to facilitate the fraudulent access.

Reciprocal healthcare fraud

Fraud relating to the use of European Health Insurance Cards (EHICs), Global Health Insurance Cards (GHICs), Provisional Replacement Certificates (PRCs), various other reciprocal healthcare arrangements and false representation during the application stage.

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Previous strategic intelligence assessments

Read the NHSCFA’s annual assessments of the NHS’s financial vulnerability to fraud from 2016-17 data onwards.