Healthcare is provided across the UK under the umbrella term of the NHS, with healthcare systems, services and entitlements differing across the four nations of England, Northern Ireland, Scotland and Wales. The NHSCFA is the health authority specifically leading in the fight against fraud, bribery and corruption against the NHS in England, which includes identification, investigation and prevention. It is accountable to DHSC and independent from other NHS bodies, both crucial components to ensuring the NHS and its patients come first.
As the NHSCFA is responsible for fraud against the NHS in England and, as an intelligence led organisation, transformation has taken place over the last few years to align to the National Intelligence Model and the Intelligence Cycle. We now analyse fraud at local, regional and national levels, both strategically and tactically, allowing for the allocation of resourcing based on demand, including for emerging and prevalent trends. Similarly, the Canadian anti-fraud centre breaks down fraud reporting and modus operandi (MO) geographically. There are also the nine Regional Organised Crime Units (ROCUs) who tackle serious crime which crosses borders, including fraud and economic crime.
The same MOs are frequently seen across trusts, ICBs and regions, as well as different countries. Collaboration and the sharing of intelligence with counterparts is crucial to tackling economic crime, including with the Four Nations, and UKHSA to allow a coordinated response to healthcare fraud across the United Kingdom.
When comparing NHS fraud against a global setting, even though the UK’s exact structure of healthcare is not mirrored elsewhere, we have seen similar manipulations among the Five Eyes countriesi and in Europe. In addition, in the United States of America fraudsters are similarly reported to alter patient pathways, perform unnecessary treatments, make use of ghost patients, accept kickbacks and perform upcoding.
However, fraud does not only occur within healthcare, but it is also an issue within every industry and sharing knowledge of the fraud landscape, highlighting fraud through intelligence products and estimating financial vulnerability to fraud are all fundamental to rivalling fraudsters. Thus, in recent years we have increased engagement and dissemination of intelligence to bodies outside of the healthcare sector.
We will continue to collaborate and expand our reach in the fight against fraud, whilst also looking to bodies that experience similar trends and threats in healthcare, as well as those experiencing fraud more generally.
- Canada, Australia, New Zealand, America, and the UK