National Tariff and Payment by Results

Fraud relating to manipulation of data and the Payment by Results (PbR) system to intentionally falsify performance in order to make a financial gain.

Funding allocated by Clinical Commissioning Groups for PbR is estimated to be around £53.5 billion for 2019-20; however, due to COVID-19, the PbR process was suspended for four months in 2020 and moved to a block contract.


from an expenditure of £35.7 billion

Calculations will be based on the spend for eight months of the year instead of the full year. Though the 4 months are calculated on previous PbR spend, block funding cannot be encompassed in the total or fraudulent figures as it was not received directly through PbR.

0.3% is estimated to be the standard percentage used to determine the rate of fraud for this area in England.

Financial fraud vulnerability: £ 107 million.

As a result of moving to a block contract for four months due to COVID-19, £29 million less was potentially lost than in the previous year.

Information reports received for National Tariff and Payment by Results

Change in the number of fraud referrals (allegations) received in relation to National Tariff and Payment by Results from 2016-17 to 2019-20.


decrease in referrals for this theme compared to last year

2016-17 2017-18 2018-19 2019-20
23 24 62 13