NHS Counter Fraud Authority publishes 2019-20 priority action areas

With new commitments to detect £22 million of fraud, prevent £100 million of fraud and recover £5 million from fraud losses.

Published: 10 June 2019

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 NHS.

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 pharmacy services.
  • 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 NHSCFA’s 2019-20 business plan, with its clear objectives around a number of core business activities.

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 care."

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

  1. The NHS Counter Fraud Authority is a Special Health Authority established under the NHS Act 2006 as amended.
  2. £1.27 billion was lost to fraud in the year 2017-18.
  3. 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
  4. NHSCFA will also support the work of the NHS Counter Fraud Service (Wales).
  5. NHSCFA works collaboratively with NHS Scotland Counter Fraud Services on fraud issues.
  6. 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.
  7. There are some 300 professionally trained and accredited Local Counter Fraud Specialists in place within health bodies across England and Wales.
  8. 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 provided.

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