Reporting trends

Between 2023 - 2024, the NHSCFA received a total of 6,367 reports alleging fraud, bribery, and corruption against the NHS in England. This is a significant increase when compared with the 5,048 reports received between 2022 - 2023.

The increase of 1,319 reports could be attributed to the first full financial year without COVID-19 restrictions impacting the NHSCFA’s 12 thematic areas. Also, the television series Fraud Squad is entering its next season in the autumn of 2024, therefore the awareness around the NHSCFA is increasing with BBC One reaching an average of 55% of the UK population weekly in 2022-23. Successful prosecution cases are being showcased to the public and individuals could therefore feel more confident reporting NHS fraud to Crimestoppers, the police, or the NHSCFA. Furthermore, the cost-of-living crisis and global landscape can often influence reporting patterns.

Top four reported areas

The NHSCFA received 6,367 reports in 2023 – 2024, of which approximately 86% related to the top four thematic areas of NHS staff fraud, patient exemption fraud, procurement and commissioning fraud and Fraudulent access to NHS care from overseas visitors.

Reporting has increased by over 26% when compared with 2022 - 2023, an increase in all but three thematic areas: dental contractor fraud, NHS Bursary fraud and data manipulation. The decrease in data manipulation can most likely be attributed to the introduction of the Health and Care Act of 2022 which made Integrated Care Boards (ICBs) statutory bodies, followed by the move to the ‘NHS payment scheme 2023-25’ in April 2023, as it takes time for the manipulations to be established and to later be noticed or detected. Similarly, the reforms to the dental contract from July 2022 onwards and the new Bursary Scheme, which has been introduced via a transitional window since August 2018, reduced the scope of NHS bursaries.

NHS staff fraud continues to be the area with the highest reporting figures of 2,963. However, this could be a direct result of oversight from colleagues and the public / patients. Reporting equates to approximately 46% of all the reports received by the NHSCFA between 2023 - 2024. The area has continued to evolve and reporting has increased over the last three years, partly due to the pandemic and the cost-of-living crisis. For example, 64% of reports related to false income and hours, which could be an attempt to supplement income and relieve financial pressures on a household. Staff were reported to be working whilst on sick leave, working elsewhere during their NHS contracted hours, and inflating income by falsely claiming for hours and services not worked, in addition to false expenses claims. Further reports were received around false representation to gain employment, nepotism in recruitment by senior staff, pay band uplift for certain shifts and services, abuse of position / NHS assets, and staff collusion.

Patient exemption fraud has received the second highest level of 1,404 reports, increasing by 61% compared to the previous year. This is assessed to be a result of COVID-19 and seasonal influenza vaccination letters which were mistakenly sent to incorrect patient addresses as almost 37% of reports related to patient registration details and patient identity theft. Following this, 28% of all reports related to prescription misuse, a majority of which relate to prescriptions being obtained by another. For example, NHS medication which is obtained genuinely for a patient being provided to another, including onward trading, exchanging, or sending abroad. Additionally, evasion of prescription, dental and / or optical cost charges accounted for 13% of all reports, with prescription charge evasion being the most prevalent of the three. An increase in reporting in this area could be due to the continued expansion of Real Time Exemption Checking (RTEC) which likely resulted in an increased number of false exemptions being identified and reported accordingly.

Reporting for procurement and commissioning of services fraud has increased from 648 reports to 723, although COVID-19 scam related reporting has significantly reduced. Increased awareness through NHSCFA interventions, such as fraud reference guides and the priority project could have impacted on reporting. For example, post-contract related reports increased when compared to the previous year, as well as reporting around false invoices, phishing emails, telephone calls and office supply scams. From the reports received about procurement and commissioning, 30% related to mandate fraud, including those where funds were prevented from diversion and the scam was unsuccessful.

Fraudulent access to NHS care from overseas visitors equates to approximately 6% of all the reports received by the NHSCFA between 2023 - 2024. The area has experienced an increase of 36% when compared to the previous annum. As this is the first full year since the 2019-20 Strategic Intelligence Assessment (SIA) to not have travel restrictions factored into the analysis reporting no longer encompasses the downward trajectory in travel. Overseas visitors entering the UK is now much closer to pre-pandemic levels than it was between 2020 and 2021, with international tourist visits estimated to reach 86% of pre-pandemic levels during 2023.