Fraud vulnerabilities within the NHS

Our assessment of the NHS’s financial vulnerability to fraud in 13 key areas.

Published: 22/07/2022

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Vulnerabilities

Image showing notepad with Procurement, Stage 1 written on it.

Procurement and commissioning

Fraud relating to the pre- and post-contract stages of the procurement and commissioning process.

Image showing document being examined by two people.

Data Manipulation fraud

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

Patient Exemption fraud

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

Image showing pharmasist at a dispensary.

Pharmaceutical contractors

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 doctor wearing a stethoscope and reading a patient chart.

General Practice (GP) contractors

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

Dental contractors

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 showing person filling out a form.

Fraudulent access to the NHS from overseas visitors

Fraud relating to inappropriate access to NHS secondary care by foreign nationals who avoid payment for services delivered.

Image showing rack of eye test equipment.

Optical contractors

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

NHS staff

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.

Image showing patient handing card to an employee.

Reciprocal healthcare

Fraud relating to overseas visitors claiming for treatment under reciprocal healthcare agreements when not entitled to do so.

Strategic Intelligence Assessment 2022
Foreword
Executive summary
Introduction
The impact of COVID-19
How do we calculate fraud vulnerability?
Annual reporting trends
Fraud vulnerability by thematic area
Previous strategic intelligence assessments

Relevant pages
The Counter Fraud Champion
Report NHS fraud
NHSCFA launches new cyber fraud awareness resource
Welcome to the NHS Counter Fraud Authority
Preventing procurement fraud in the NHS

We estimate that the NHS is vulnerable to £1.198 billion worth of fraud each year.

Report any suspicions or concerns about fraud against the NHS to the NHSCFA.

Help stop NHS Fraud. Start an online report >>

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