Information requested

As we understand, the NHS Counter Fraud Authority collect data on fraud or attempted fraud by foreign nationals who receive free healthcare to which they are not entitled. NHS employees and members of the public are encouraged to report any suspicions of fraud or attempted fraud to the NHS Counter Fraud Authority.

The 6 FOIs below relate to the category of fraudulent activity detailed above.

  1. Please provide the number of reports of fraudulent activity that have been reported to the NHS Counter Fraud Authority relating to foreign nationals who receive free healthcare to which they are not entitled (from 2015-2020 inclusive). If possible, please provide a breakdown of number of reports from each individual NHS Trust. Please split the reports into:
    1. Patients committing an act of/attempted act of fraud
    2. Trusts committing an act of/attempted act of fraud
    3. Healthcare professionals committing an act of/attempted act of fraud
  2. For answers 1a) b) and c) please provide details of what source the reports originate from. For example the proportion reported by individuals directly to the NHSCFA online/via telephone, the proportion reported through Local Counter Fraud Specialists.
  3. For answers 1a) b) and c) please provide details of the number of these reports that have been further investigated by the NHSCFA
  4. For answers 1a) b) and c) please provide details of the number of cases where the NHSCFA sought to apply criminal or civil sanctions. In how many have sanctions been successfully applied?

    5. We have created an excel spreadsheet template (attached to this email) for you to provide the data requested in questions 1-4. There are 3 sheets corresponding to Q1a-c. We hope this helps, feel free to adapt the spreadsheet as needed.

  5. Please provide documents/guidance on how reports of fraudulent activity are handled and how the decision is made to actively investigate a claim.
  6. Please provide details on how much has been spent on communication material to NHS trusts in relation to the fraudulent activity mentioned above (from 2015-2020 inclusive).

NHSCFA response

In response to the request, I am attaching a spreadsheet containing data held by NHS Counter Fraud Authority in respect of Overseas Visitor Fraud

Our data relies on Overseas Visitors Managers (OVMs) in Primary and Secondary Care Providers reporting cases of suspected fraud.

OVMs would usually report unrecovered Overseas Visitor charge information to the Department of Health and Social Care Cost Recovery Team.

I would suggest that you contact the DHSC Cost Recovery Team requesting data on ‘unrecovered Overseas Visitor charges’ (as these cases may not be referred to as fraud).

With reference to the data attached, the sub fraud area recorded as ‘overseas visitors’ falls within the category of ‘patient fraud’ and therefore data held/provided is for this category only.

5. Please provide documents/guidance on how reports of fraudulent activity are handled and how the decision is made to actively investigate a claim.

All information provided to the NHSCFA is handled professionally, sensitively and in accordance with the law.

NHS Counter Fraud Authority (NHSCFA) investigates fraud and corruption in the National Health Service. Our staff within the Intelligence Unit provide an initial triage for all reports received by us, to decide if the matter reported can be handled by the NHSCFA or needs to be passed to a third party organisation.

Officers of the Intelligence Unit develop reports in line with organisational priorities, considering the strength and relevance of the evidence, as well as an evaluation of the source providing the information. The reports have three main disposal routes:

    1. The report is sent to the relevant Local Counter Fraud Specialist for further development

    2. An intelligence package relating to the report is reviewed at the Tactical Tasking and Co-ordination Group for suitability for investigation by NHSCFA National Investigation Service.

    3. No further action is taken by NHSCFA.

    It is not always possible to start an investigation for every item of information we receive. However, we retain information to help increase knowledge of Department of Health and Social Care, NHS and wider health group fraud and we review decisions as new information becomes available.

    6. Please provide details on how much has been spent on communication material to NHS trusts in relation to the fraudulent activity mentioned above (from 2015-2020 inclusive).

The majority of information and resources NHSCFA disseminates out to the sector is via our digital channels e.g. secure extranet and corporate website. These products are produced in-house and in digital format only for trusts to print themselves if they wish Fraud awareness | Fraud Prevention | NHS Counter Fraud Authority (cfa.nhs.uk).

We have not developed any materials at cost specifically relating to overseas visitors

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2021002 Overseas Visitors Data