The month of April marks the beginning of the NHS Counter Fraud Authority’s (NHSCFA) first full financial year of activity. One of our very first actions in 2018-19 was to publish our business plan, which sets out our strategic priorities for the year.

To set our priorities we carry out a strategic tasking exercise in accordance with the NHSCFA control strategy. The process involves evaluating the results of our annual strategic intelligence assessment through a risk modelling methodology which is widely used by law enforcement bodies in the UK. This methodology takes into account not only the estimated loss to fraud, but also factors such as the impact on the community and the ability of the NHSCFA to effect change.

As a result of this process the NHSCFA’s control strategy priorities for 2018-19 are as follows:

  • Fraud in relation to NHS Help with Health Costs (patient charge evasion)

    Patients claiming entitlement to free or discounted NHS treatments or services, such as prescriptions, dental treatments or optical services, when they are not eligible. This is a prevalent fraud risk affecting the NHS.

  • Pharmaceutical contractor fraud; threats associated with the production and supply of bulk blank prescriptions

    Pharmaceutical contractor fraud occurs when these contractors claim for remuneration and the reimbursement of fees by the NHS for services that have not been provided.

  • Fraud in relation to procurement and commissioning in the NHS; threats associated with post-contract invoice manipulation

    Procurement and commissioning fraud in relation to post contract invoice manipulation occurs when payments are made by the NHS from fraudulently submitted claims for work either partially or not carried out.

  • Driving improvements in standards of counter fraud work in the NHS

    The NHSCFA aims to lead, guide and influence the improvement of standards in counter fraud work, in line with HM Government Counter Fraud Professional Standards, across the NHS and wider health group. As part of work on this priority, we are looking to set up a stakeholder engagement group to help us improve our understanding of what is required to enable effective counter fraud work in the NHS. Watch this space for more updates on this.

Now that we have identified our strategic priorities for the year, what are we going to do about them? The business plan sets out objectives and deliverables for each of the priorities, and explains how we are going to measure our performance against them. Please read the document for more details.