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
||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.
and approaches to
detection of fraud
||The phased implementation of
Real-Time Exemption Checking
(RTEC) is ongoing. We will
undertake measurement activity to
determine the level of success at
||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
||We will undertake
in the thematic area
||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
||Working with stakeholders to reduce
||Building and delivering
approaches to support
the detection of fraud.
|Payment by Results
and national tariff
||Assessing impact and fraud
vulnerabilities due to changes to
blended payments and block
||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.
||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.