We have used intelligence from across the health sector, focusing on key thematic areas, to support the business planning process. This intelligence, gathered in the NHSCFA’s Strategic Intelligence Assessment, has helped drive our areas of focus for the 2022-23 financial year.
| Strategic Priority Thematic Area | Supporting intelligence | Delivery plan action |
|---|---|---|
| Pharmaceutical contractor fraud | Ongoing analysis of out of pocket expenses has demonstrated outliers and anomalies within the claim cycle Collaboration with key stakeholders will continue to target inappropriate claiming and error. | Building and delivering data analytical capability and approaches to support the detection of fraud |
| Patient exemption fraud | The phased implementation of Real-Time Exemption Checking (RTEC) is ongoing. We will undertake measurement activity to determine the level of success at countering fraud | Deliver intelligence assessments that identify fraud threats and enablers |
| Procurement fraud | Mandate fraud is the highest reported sub-theme within procurement. The mandate fraud project has been suggested to obtain a greater understanding on the scale and extent of the threat and design control mechanisms. | We will undertake prevention activity in the thematic area of payment diversion fraud. |
| Commissioning of services fraud | With the introduction of Integrated Care Boards (ICBs), NHSCFA working with partners to introduce counter fraud measures at the point of implementation. | We will continue to work with NHS partners to build strong counter fraud relationships. |
| Dental contractor fraud | Working with stakeholders to reduce vulnerability | Building and delivering data analytical capability and approaches to support the detection of fraud. |
| Payment by Results and national tariff fraud | Assessing impact and fraud vulnerabilities due to changes to blended payments and block payments. | Deliver intelligence assessments that identify fraud threats and enablers. |
| Staff fraud | Staff fraud is the highest reported thematic area with high volume low value allegations. Assessment of the thematic area is ongoing to devise and recommend effective counter fraud functions. | Deliver intelligence assessments that identify fraud threats and enablers |
| General Practice fraud | Monitoring and assessing the proposed changes to the GP General Medical Services (GMS)contract. | Monitoring and assessing the proposed changes to the GP GMS contract |
| Optical contractor fraud | Intelligence has remained static. | Monitoring and assessment of this area continues. |
| Thematic Area | Supporting intelligence | Delivery plan action |
|---|---|---|
| Reciprocal healthcare fraud | Monitoring and assessing the implementation of post-Brexit reciprocal health arrangements | Working with DHSC to obtain a greater understanding of the fraud vulnerabilities |
| Fraudulent access to secondary care | Similar to EHIC reciprocal healthcare fraud. Watching brief waiting for post Brexit migration / border migration/border controls to be implemented before assessments can be made | Working with DHSC to obtain a greater understanding of the fraud vulnerabilities. |