Data manipulation fraud

The decrease in financial vulnerability can be attributed to the COVID-19 pandemic and the NHS moving to block contracts. Therefore, funding changed and the previous formula used by the NHSCFA to determine expenditure was no longer applicable.

With the new ICB structure implemented in July 2022, it is a realistic possibility for clinicians to abuse their position to acquire more favourable allocations. When determining the level of the fixed element and funding distributions, they may collude with, or be coerced by, certain bodies.

ICB funding, inaccurately distributed or manipulated, is a possibility as the main allocation formula for ICBs uses population density and registrations to each GP practice within the system. Discrepancies within GP registrations/patient lists will directly affect ICB funding allocations.

It is extremely likely that data is falsified to meet targets or hide undesirable outcomes in secondary care. Hospitals may move patients under A&E reporting data instead of a noninpatient short stay unit, possibly to avoid surpassing the care completion time within the unit.

There is the potential for patient transport data to be manipulated to avoid fines by altering patient pick-up times and avoid surpassing the maximum waiting time. This may be achieved through delays and cancellations, as well as employing an individual to manipulate the figures.

The funding structure has the potential to incentivise abuse through activity data being falsified to maintain or increase funding. For example, a trust failing to provide contracted services yet falsifying activity data to appear as if the services were running, and as such, continue to accept funding.

Information reports received for data manipulation fraud

Potentially due to the difficultly in distinguishing between fraud and error, reporting is often low in this area. The implementation of the new statutory ICB structure may have also caused a further decrease in reporting, from 17 allegations in 2021 – 2022 to 15 this reporting period. Reporting may increase once there is a full understanding of the new processes and potential manipulations.

The change in the number of fraud reports received in relation to data manipulation from 2018 – 2019 to 2022 – 2023 is illustrated in the below chart: