Each year, the NHS Counter Fraud Authority (NHSCFA) sets a number of priority areas for action based on the organisation’s latest evaluation of available intelligence on the fraud risks facing the NHS. The Authority’s strategic intelligence assessment based on data for the 2017-2018 financial year forms the basis for its four priority action areas for 2019-2020, which are pharmaceutical contractor fraud, procurement and commissioning fraud, fraud in relation to general practice contractors and improving fraud outcomes within the NHS.
In terms of pharmaceutical contractor fraud, the NHSCFA will work in collaboration with the NHS Business Services Authority to identify key areas of loss to fraud and identify potential fraud by contractors providing community pharmacy services.
When it comes to procurement and commissioning fraud, the Authority determines to work with NHS organisations to measure fraud risk vulnerability indicators in the area of procurement fraud and develop updated prevention guidance. By working collaboratively with colleagues across the NHS, the NHSCFA aims to deliver work that will lead to a measurable reduction in procurement fraud.
The priority area of fraud in relation to general practice contractors will have a keen focus on GP capitation fees. The NHSCFA will work with colleagues in NHS primary care to increase confidence in assessments of the losses to fraud in this area and form a basis for fraud prevention activity.
Collaboration and engagement
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..
Sue Frith, interim CEO of the NHSCFA, has explained 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 absolutely sure that counter fraud work at both the national and local levels 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 and £5 million in recoveries from fraud losses.
These priorities and targets are best understood alongside the NHSCFA’s 2019-2020 Business Plan, with its clear objectives around a number of core business activities.
Frith concluded: “We hope that 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, 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.”