Priority Areas For The NHS Counter Fraud Authority Revealed

The NHS Counter Fraud Authority (NHSCFA) has set out its priority areas for action, based on the current fraud risks facing the health service, with fraud in relation to GP contractors and capitation fees one of the main areas for concern.

The organisation is now set to work alongside colleagues in NHS primary care to help increase confidence in its assessment of the losses to fraud where this is concerned, forming a basis for fraud prevention activity.

It will also be focusing its attention on pharmaceutical contractor fraud, working with the NHS Business Services Authority to find areas of loss to fraud and identify potential problems with contractors that provide community pharmacy services.

Another key area being prioritised is procurement and commissioning fraud, with fraud risk vulnerabilities set to be measured in this area in order to develop updated prevention guidance. The aim is to work in a collaborative fashion with colleagues throughout the health service to deliver work that will result in a measurable reduction in this kind of fraud.

Improving fraud outcomes across the NHS is also a priority, with a drive to increase the number of sanctions imposed because of local counter fraud activity, as well as improving the quality of referrals to enable enforcement action.

The headline targets for the year 2019-2020 are £22 million in detected fraud, £100 million in prevented fraud and £5 million in recoveries from fraud losses.

“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,” interim CEO of the NHSCFA Susan Frith said.

The body also recently published a reference guide to help healthcare professionals find information and resources on the different types of fraud that affect the NHS. It forms part of a wider programme of work that intends to increase understanding of fraud risks, while providing prevention advice and guidance to help mitigate the risks.

There are different sections that cover the likes of staff and patient fraud, or issues with suppliers, NHS systems or third parties (people or organisations not associated with the NHS but trying to gain financially from it).

If you or a colleague identifies NHS fraud, suspicions or concerns can be reported to the NHSCA by calling the free 24-hour reporting line, or filling in a form online. All reports will be treated in confidence and you’re also able to report anonymously. If you’re an NHS employee, you can report suspicions of fraud to a local counter fraud specialist.

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