Scrutton Bland Counter Fraud Newsletter Autumn 25

Where are the main risks?

Key highlights Drawing on the Annual Report and Accounts 2024-2025 and the Strategic Intelligence Assessment 2025. An estimated £1.346 billion of NHS funding is vulnerable to fraud, bribery, or corruption this year. Although this is a numeric increase from last year, it actually represents a slightly smaller proportion of the NHS budget, now 0.72%, showing that counter fraud measures are starting to have an effect even as spending rises. The NHSCFA and the wider health group delivered £196.8 million in counter fraud outcomes for 2024–25, comfortably surpassing the annual target of £145.1 million. This figure includes results from direct enforcement, local counter fraud specialist (LCFS) work, technology projects, and partnership activities. Project Athena, NHSCFA’s in-house data analytics and machine learning initiative, alone contributed over £28 million to these outcomes in its first year. The NHSCFA received 6,462 reports of suspected fraud in 2024/25, which is an increase of 95 from the previous year.

Estimated Risk (£m)

Reports Received

Area

Procurement & commissioning fraud

£392.5

537

Patient exemption fraud

£230.2

1,238

Data manipulation fraud

£189.1

Community pharmaceutical contractor

£135.2

238

GP contractor fraud

£116.7

233

Optical contractor fraud

£90.7

Dental contractor fraud

£57.6

NHS staff fraud

£27.8

3,211

These figures reflect areas where funding is judged most at risk based on internal monitoring, referrals, and past incidents.

Key issues and trends this year Staff fraud remains the most reported category, particularly false claims about hours worked, dual working while on sick leave, and misuse during recruitment. Procurement fraud holds the highest estimated risk in monetary terms and continues to be a major area for policy and process improvement. Enhanced supplier checks and local proactive exercises, with over 390 undertaken in England in 2024-25, have already led to changes in NHS policy and procedures. Patient exemption fraud remains common, especially involving prescription charges and dental fees. Real-Time Exemption Checking technology is helping reduce financial loss. Emerging threats include people impersonating NHS workers to carry out bank shifts, as well as continued cyber-facilitated fraud like phishing and data breaches that target health data. Data-driven tools : Project Athena, launched at the start of 2024, now uses AI and machine learning to spot unusual activity faster and help teams focus their efforts. Collaboration : There has been wide cross- sector engagement between NHSCFA, NHS trusts, NHS England, and other partners to share intelligence and take targeted action.

What’s happening on the ground? Reporting levels are on the rise; 83.2% of all reports relate to staff fraud, patient exemptions, procurement, or access to care by overseas visitors. Over 390 local prevention exercises were run across England, especially targeting procurement systems. Policy changes and improvements in internal controls are being put in place at both national and local organisation level based on findings from real cases and proactive work. Looking ahead The NHSCFA is focusing next on further supporting staff fraud prevention, increasing data-driven detection, and helping health and care teams turn intelligence into real, practical controls. There’s also a newly established working group focusing specifically on NHS staff fraud in view of its consistently high reported numbers. Every staff member can make a difference by staying informed about fraud risks, being confident in reporting suspicions, and using available prevention tools. NHS teams continue to protect both patient care and public funding. The full SIA and Annual Report provide more intelligence and advice to help all parts of the health and care community meet the challenge and can be read online here: