How do we calculate fraud vulnerability?

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

Published: 13 September 2023

NHSCFA assesses how financially vulnerable each thematic area is to fraud, bribery, and corruption. To achieve this, the NHSCFA adopts a different approach depending on nuances within each area. However, broadly speaking the two main methods are:

  1. Loss measurement exercises – These take the form of an in-depth analysis and measurement of a particular area to provide a statistically robust percentage of how much funding/reimbursement is vulnerable to fraud. This method provides the NHSCFA with the highest confidence.
  2. Comparative loss assessments – Where the NHSCFA has not directly measured, we are reliant on vulnerability percentages derived from partners or stakeholders. These may not be 100% comparable, therefore, the NHSCFA has the least confidence in them.

Within the SIA, a consistent language has been used when assessing the probability and uncertainty with the ‘probability yardstick’ defining the language applied to the range. In using the probability spectrum, the NHSCFA has considered the source, age and reliability of the material used, and any extenuating factors to form the assessment. There is no weighting attached to specific factors, but rather a comprehensive approach taken when assigning the probability and uncertainty.

Table showing the NHSCFA's probability spectrum
Percentage range Likelihood of occurence
0% - 5% Remote chance
10% - 20% Highly unlikely
25% - 35% Unlikely
40% - 50% Realistic possibility
55% - 75% Likely / probable
80% - 90% Highly likely
95% - 100% Almost certain

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