Strategic Intelligence Assessment 2023

Image showing Alex Rothwell, Chief Executive Officer

Foreword

Alex Rothwell, Chief Executive Officer of the NHSCFA, introduces the 2023 Strategic Intelligence Assessment.

Image showing an NHSCFA poster with the words stop fraud above a raised hand making a stop gesture

Executive summary

A brief overview of the NHS’s overall vulnerability to fraud, bribery and corruption.

Image showing two people shaking hands over a desk

Introduction

Why the NHSCFA produces an annual strategic intelligence assessment, and how the content should be interpreted.

Image showing virus cells with one hilighted in orange

The impact of COVID-19

How the pandemic has affected fraud reporting levels, the accuracy of activity data and the level of resources to combat fraud.

Image showing three peoples hands pointing as figures on a document with a seperate document on the desk below highlighted in orange

How do we calculate fraud vulnerability

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

Image showing a person lokking at a document sitting infront of a laptop computer

Annual reporting trends

Levels of fraud reporting received by the NHSCFA compared to previous periods.

Image showing a orange highlighted notebook with the words procurement process stage 1 written on the cover

Procurement and commissioning of services fraud

Fraud relating to pre- and post-tender stages of the procurement and commissioning process, and mandate fraud

Image showing a doctor wapping a persons and in bandages

Patient exemption

Fraud vulnerabilities relating to prescription charge evasion, dental charge evasion and optical voucher abuse.

Image showing two people discussing a document in front of them

Data manipulation

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

Image showing a pharmacist looking at a pescription hightlighted in orange

Community pharmaceutical contractor

Fraud relating to inappropriate claims for dispensing and enhanced services offered by community pharmacies, inflated claims under the drug tariff or activities that contravene contractual terms.

Image showing a GP looking at a orange hilighted tablet computer

General Practice (GP) contractor fraud

Fraud relating to the manipulation of income streams or activities that violate contractual terms perpetrated by either GPs or practice staff.

Image showing optomitrist carring out an eye exam

Optical contractor fraud

Fraud relating to inappropriate claiming or dispensing at the optical practice, or care provided in homes, nursing, residential or day care facilities.

Image showing a dentist checking an xray of a patients teeth

Fraud relating to inappropriate claiming or dispensing at the dental practice relating to services delivered as defined by the contractual agreements, or private work carried out and its impact on the NHS.

Image showinga group of NHS staff wearing lab coats

NHS staff fraud

Fraud relating to members of NHS staff who fraudulently inflate or falsify their income, expenses or working hours for financial gain, or who assume a false identity.