How do we calculate fraud vulnerability?

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

Published: 22/07/2022

NHSCFA assesses how financially vulnerable the current strategic priority and intelligence collection areas are to fraud. In order to achieve this the NHSCFA adopts a different approach depending on the nuances of the area. However, broadly speaking the two main ways are:

  1. Loss measurement exercise - These take the form of an in-depth analysis and measurement of a particular area to provide a statistically robust percentage of how much of the funding / reimbursement is vulnerable to fraud. Out of the two methods the NHSCFA has the highest confidence in this method.
  2. Comparative loss assessment – Where the NHSCFA has not directly measured an area, we are reliant on vulnerability percentages derived from partners or stakeholders to use. These may not be 100% comparable so therefore the NHSCFA has the lower confidence in them.

Within the SIA a consistent language has been used across thematic areas when assessing the probability and uncertainty. The ‘probability yardstick’ defines the language applied to the range.

In using the probability spectrum, the NHSCFA has taken into account, the source, the age and reliability of the material used and any extenuating factors to form the assessment. No particular weighting is attached to specific factors but rather a comprehensive approach is taken when assigning the probability and uncertainty.

Percentage range Likelihood of occurence
0% - 5% Remote chance
10% - 20% Highly unlikely
25% - 35% Unlikley
40% - 50% Realistic possibility
55% - 75% Likely/ probable
80% - 90% Highly likely
95% - 100% Almost certain