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NHS Counter Fraud Authority identifies key areas for investigation in 2019/20

General practice contracts, pharmaceutical contractors and procurement and commissioning will be the key areas investigated by the NHS Counter Fraud Authority in the coming year.

It set out these fields for fraud probes in its annual statement of priority action, based on available intelligence on fraud risks facing the NHS. Fraud in 2017-18 cost the NHS £1.27bn.

The authority will work with the NHS Business Services Authority to identify the main potential losses through fraud from contractors providing community pharmacy services, and with a range of NHS organisations to measure fraud risk vulnerabilities in procurement.

Its work on GPs will focus on capitation fees, the system where lump sum payments are made to care providers based on the number of patients in a target population but not linked to how much care is provided.

There will be a drive to increase the number of sanctions imposed as a result of local counter fraud work and to improve the quality of referrals enabling enforcement action to be taken.

Authority interim chief executive Susan Frith said: “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.”

There will be a set of financial targets used to measure the effectiveness of counter fraud work for 2019-20:

  • £22m in detected fraud
  • £100m in prevented fraud
  • £5m in recoveries from fraud losses

Mark Smulian