The NHSCFA estimates that the NHS is vulnerable to £136 million worth of National Tariff and Performance Data manipulation fraud each year.
Fraud in relation to national tariff and performance data manipulation relates to the intentional falsification of data and the Payment by Result (PbR) system.
The current system is set up in such a way that commissioners are dependent on data received from providers in order to monitor the quality of services and ultimately calculate payments.
The deliberate manipulation of data results in both NHS performance being falsified, and vital patient funds being fraudulently obtained.
For a full list of fraud types in this category, please check NHS systems in the fraud definitions.
To assist you on how to spot the signs of National Tariff and Performance Data manipulation and how to put measures in place to stop this type of fraud, please see below.
- Are diagnoses and procedures being recorded more than once or unnecessarily or are only the most expensive diagnosis being selected for a patient (up-coding) when there is no need to do so?
- Are patients being discharged and readmitted inappropriately to attract additional payments? For example, from Accident & Emergency
- Are patients being deliberately kept in hospital for longer, so they attract the full tariff or are patients stays being manipulated so they fall into the high outlier category?
How to report fraud
Report any suspicions of fraud or attempted fraud to the NHS Counter Fraud Authority online at https://cfa.nhs.uk/reportfraud or through the NHS Fraud and Corruption Reporting Line 0800 028 4060 (powered by Crimestoppers). All reports are treated in confidence and you have the option to report anonymously. You can also report to your nominated Local Counter Fraud Specialist if you are an NHS employee or contractor.