Newly launched: the NHS Counter Fraud Authority

Following its launch on 1 November, Rianne Endeley-Brown introduces the new special health authority responsible for investigating and countering fraud against the NHS

The NHS Counter Fraud Authority (NHSCFA) is a new special health authority dealing with fraud, bribery and corruption against the NHS. Its launch on the 1 November 2017 marked a renewed focus on economic crimes carried out against the NHS and the wider health service. With this focus comes a need for our intelligence-led organisation to better understand fraud risks, as well as the capacity to investigate serious and complex fraud cases.

So what is fraud? Essentially, it is the crime of using deception to make a personal gain. It is a crime that many are familiar with, whether they have experienced it first-hand or have seen warnings about it.

Fraud against the NHS costs an estimated £1.25 billion a year (based on 2015-16 data), which is roughly one per cent of the total health budget. By ‘fraud’ in this case we mean a range of economic crimes including fraud, bribery and corruption or any other illegal act that is committed by an individual or group of individuals to obtain a financial or professional gain.

There are many different areas of NHS fraud, with the biggest estimated to be procurement fraud, patient fraud and dental contractor fraud (please see the full break-down of the £1.25 billion figure below). Simon Hughes, interim chair of the NHSCFA, said that ‘every fraud takes a service away from someone that needs it’. £1.25 billion is enough money to fund 40,000 staff nurses, or 5,000 frontline ambulances.

The NHSCFA has formulated a three year strategy, with five main objectives: delivering the Department of Health’s strategy, vision and strategic plan, and lead counter fraud activity in the NHS in England; being the single, expert, intelligence-led organisation providing a centralised investigation capacity for complex economic crime matters in the NHS; leading, guiding and influencing the improvement of standards in counter fraud work; taking the lead and encouraging fraud reporting across the NHS and wider health group; and investing in and developing NHSCFA staff.

Going forward, the NHSCFA is putting extra effort into preventative measures. It is important to circulate information to stakeholders so that they are informed of the work the organisation is doing as well as ensuring that the information is fed down the line to frontline employees and contractors, patients and the public.

The NHSCFA will draw on the intelligence gathered to investigate complex and serious fraud cases. In doing so, we will analyse the weaknesses fraudsters are exploiting and work on strengthening those areas. Financial losses in the NHS due to fraud divert precious resources away from patient care. Danny Mortimer, CEO of NHS Employers, says that ‘it is unacceptable that the money lost each year is depriving patients of investment in their services’. Wherever possible, NHSCFA financial investigators will exercise their powers under the Proceeds of Crime Act to recover losses and investigation costs.

The NHSCFA is making it as easy and accessible as possible for people to report their suspicions of fraud. Under-reporting leads to limited knowledge and lack of data, and ultimately an incomplete intelligence picture. The organisation aims to ensure that fraud is investigated properly. Simon Hughes claims that ‘simply reporting your concerns is a powerful action to protect healthcare’. Reporting your suspicions or any knowledge you have regarding fraud against the NHS is a huge step in helping to protect the health service’s resources.

The NHSCFA will seek to reduce the impact of fraud as well as prevent it from happening in the first place. Preventing fraud and deterring fraudsters is at the heart of the organisation. To do so, the organisation is developing a range of communications and marketing strategies to raise the profile of the NHSCFA and the awareness of fraud and how to report it properly. We use social media to engage with our audiences (you can find us on Twitter, Facebook and LinkedIn), and you can find more information about us on our new website. The website also shows how to report fraud through the correct channels such as the online reporting tool and the Crimestoppers-powered telephone reporting line.

Also available on the NHSCFA’s website is a fraud awareness ‘toolkit’ that encourages the user to participate in raising awareness of fraud against the NHS. The webpage features downloadable and printable posters that can be displayed in office spaces, as well as online banners that can be used for social media sites. Although fraud is a crime committed by only a minority, it has a significant impact on the NHS and its resources.

The NHS Counter Fraud Authority is clear in its message that fraud is a major problem within the NHS, and that it takes away money from people who need care. We will not tolerate this and will do everything within our powers to prevent fraud against the NHS. Health Minister Lord O’Shaughnessy said ‘we created the NHS Counter Fraud Authority so that...there is a dedicated NHS organisation to tackle health service fraud and corruption and bring fraudsters to justice’. And that is exactly what the NHS Counter Fraud Authority will be doing.

The forms of fraud
Frauds against the NHS can come in many different forms and here are examples of just a few of them:

Timesheet fraud: includes falsifying timesheets and trying to obtain money for hours not actually worked.

Procurement fraud: exploiting the purchasing of goods and services by an NHS organisation. An example is bid rigging, when bidders agree between themselves to eliminate competition, denying the organisation a fair price or delivering poor quality goods or services.

False claims: This can range from patients claiming for free treatment when they are not entitled to it, to NHS professionals claiming money for services they have not provided.