NHSCFA Thematic Fraud Areas

This section provides a detailed look at 13 key areas of fraud, including examples and prevention advice.

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NHS Fraud Reference Guide
Thematic Fraud Areas

Procurement & commissioning fraud

Procurement and commissioning fraud relates to allegations of collusion, bribery and corruption within the pre-tender stages of the procurement and commissioning process. It also relates to false, intentionally inflated or duplicate invoices within the post tender stages.

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Pharmaceutical contractor fraud

Pharmaceutical contractor fraud relates to false claims for either the dispensing of items or for one of the enhanced services offered at the pharmacy.

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Help with Health Costs

Patient fraud relates to an individual who is not entitled to free NHS treatment, services or medication but who purports to be exempt from paying for the costs of prescription charges, dental treatment and optical services.

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NHS staff fraud

NHS staff fraud relates to a member of staff who fraudulently inflates or falsifies their income, expenses or working hours for financial gain.

National tariff & performance data manipulation

Fraud in relation to national tariff and performance data manipulation relates to the intentional falsification of data and the Payment by Result (PbR) system.

General practice fraud

General Practice fraud relates to the manipulation of income streams or activities that violate contractual terms perpetrated by either practitioners or staff members.

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EHIC fraud

European Health Insurance Card fraud occurs when overseas visitors claim for treatments under EHIC when they are not entitled to do so.

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Optical contractor fraud

Optical Contractor fraud occurs when optical contractors (opticians) submit fraudulent claims to the NHS for a range of services provided to patients.

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Dental contractor fraud

Dental Contractor fraud occurs when dental contractors (dentist) submit fraudulent claims to the NHS for a range of services provided to patients.

Fraudulent access to NHS care

Fraudulent access to NHS care relates to foreign nationals who obtain free healthcare to which they are not entitled.

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NHS pension fraud

NHS Pension fraud relates to an individual who has either falsified their circumstances or failed to notify of a significant change in their circumstances to the pension administration.

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Fraud against NHS Resolution

Fraud against NHS Resolution relates to fraudulent accidents/ insurance claims under the Liabilities to Third Parties Scheme (LTPS) or through clinical negligence.

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NHS student bursary fraud

NHS Student Bursary Scheme fraud relates to false applications or the use of false documents to support a bursary application, other NHS funded training or financial support stream.

Fraud Reference Guide
Types of Fraud within the NHS
NHSCFA Thematic Fraud Areas
Cyber Fraud
Dos and Don’ts when reporting fraud

Relevant pages
NHSCFA announces new loss measurement exercise
Fraud vulnerabilities within the NHS
NHS Counter Fraud Authority publishes 2019-20 priority action areas
Trucks deliver NHS fraud message
Fraud bosses warn against manager cuts

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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