Each year the NHS Counter Fraud Authority (NHSCFA) sets a
number of priority areas for action, based on its latest
evaluation of available intelligence on the fraud risks facing the
The NHSCFA’s strategic intelligence assessment based on data
for the 2017-18 financial year forms the basis for its four
priority action areas for 2019-20, which are:
- Pharmaceutical contractor fraud - We
will work in collaboration with the NHS Business Services
Authority (NHSBSA) to identify key areas of loss to fraud and
identify potential fraud by contractors providing community
- Procurement and commissioning fraud -
We will work with NHS organisations to measure fraud risk
vulnerabilities indicators in the area of procurement fraud and
develop updated prevention guidance. By working collaboratively
with colleagues across the NHS we aim to deliver work that will
lead to a measurable reduction in procurement fraud.
- Fraud in relation to general practice
contractors - This priority area will focus on GP capitation
fees. We will work with colleagues in NHS primary care to
increase confidence in our assessment of the losses to fraud in
this area and form a basis for fraud prevention activity.
- Improving fraud outcomes in the NHS -
Collaboration and engagement with those who manage delivery and
support counter fraud provision in the NHS will be focused on the
effectiveness of this work in terms of the financial impact of
enforcement activity. There will be a drive to increase the
number of sanctions imposed as a result of local counter fraud
work and improve the quality of referrals enabling enforcement
action to be taken..
Susan Frith, Interim CEO of NHSCFA, explains that
collaboration is a theme common to the organisation’s approach to
all four priority areas:
"By setting clear goals based on the national intelligence
picture of fraud risks and working with colleagues across the NHS
to deliver them, we can make sure counter fraud work at both
national and local level is focused on achieving measurable
outcomes. In order to measure the impact of NHS counter fraud work
we will use a set of financial targets, which for the first time
this year include a measure of the value of prevented fraud."
The headline targets for 2019-20 are:
- £22 million in detected fraud
- £100 million in prevented fraud
- £5 million in recoveries from fraud losses
These priorities and targets are best understood alongside
business plan, with its clear objectives around a number of core
Ms Frith concludes:
"We hope measuring local and national counter fraud work
against these targets will highlight the positive impact that
tackling fraud has on NHS resources. By preventing fraud, by
identifying it and tackling it effectively where it occurs, and by
seeking to recover moneys lost to fraud we can ensure that
precious NHS funds are used for their intended purpose of patient
If you suspect that anyone is committing fraud or
another economic crime against the NHS, tell NHSCFA about it -
you can call our 24-hour, confidential reporting line 0800 028 40 60 or visit our main website to report online: www.cfa.nhs.uk
"NHS fraud. Spot it, report it, together we stop it"
For more information contact the NHSCFA press
office on 020 7895 4519/4524.
Notes to Editors
- The NHS Counter Fraud Authority is a Special Health
Authority established under the NHS Act 2006 as amended.
- £1.27 billion was lost to fraud in the year 2017-18.
- When NHSCFA uses the term ‘fraud’, we refer to a range of
economic crimes, such as fraud, bribery, corruption or any other
illegal acts committed by an individual or group of individuals
to obtain a financial or professional gain
- NHSCFA will also support the work of the NHS Counter
Fraud Service (Wales).
- NHSCFA works collaboratively with NHS Scotland Counter
Fraud Services on fraud issues.
- NHSCFA will work closely with NHS Local Counter Fraud
Specialists across the NHS in England to ensure that healthcare
crime is tackled and a culture of fraud prevention and deterrence
is in place.
- There are some 300 professionally trained and accredited
Local Counter Fraud Specialists in place within health bodies
across England and Wales.
- Capitation is a payment system where lump-sum payments
are made to care providers based on the number of patients in a
target population, to provide some or all of their care needs.
The capitation payment is not linked to how much care is