Data manipulation fraud

Fraud relating to manipulation of data and payment systems to intentionally falsify performance in order to make a financial gain.

Published: 13 September 2023


vulnerable from an expenditure of £51.96 billion

Data manipulation includes falsifying data to meet targets, increase revenue or hide undesirable outcomes. Previously encompassing Payment by Results and National Tariff fraud, latterly block contracts, and now Integrated Care Board (ICB) funding.

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 Therefore, funding changed and the previous formula used by the NHSCFA to determine expenditure was no longer applicable.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:

Table showing the number of fraud reports received in relation to data manipulation fraud from 2018 – 2019 to 2022 – 2023
2018 to 2019 2019 to 2020 2020 to 2021 2021 to 2022 2022 to 2023
2018 to 2019 44 2019 to 2020 37 2020 to 2021 15 2021 to 2022 17 2022 to 2023 15

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