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FOR THE HEALTH AND SOCIAL CARE SECTOR COUNTER FRAUD
NEWSLETTER
Contents
New Year, New Scams: What could be in store for 2025?
NHS Neonatal Manager Sentenced For Fraud
NHS Nurse Receives Fine and Suspended Sentence
NHSCFA Strategic Intelligence Assessment 2024
New Guidance Released for Corporate Fraud Prevention Offence
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Introduction
The Strategic Pillars The NHSCFA 2023-2026 Strategy:
Welcome to our Winter Counter Fraud Newsletter. The NHS Counter Fraud Authority (NHSCFA) estimates that the NHS is vulnerable to over £1.3 billion worth of fraud each year. Fraud is deception carried out for personal gain, usually for money. Fraud can also involve the abuse of a position of trust. By ‘NHS fraud’ we mean any fraud where the NHS is the victim. While those who commit fraud against the NHS are a small minority, their actions have a serious impact on us all. Fraud against the NHS could be committed by anyone. This includes members of staff, patients, contractors, suppliers, medical professionals and external parties, such as cybercriminals.
‘Working together to understand, find and prevent fraud, bribery and corruption in the NHS’ focuses on four key pillars: Understand, Prevent, Respond and Assure.
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Understand how fraud, bribery and corruption affects the NHS.
Fraud takes taxpayers’ money away from patient care and into the hands of criminals. Everyone has a part to play in fighting fraud and being aware of the risk and remaining vigilant are the most important first steps, followed by knowing how to report fraud. Contact details for reporting fraud in confidence are included at the end of this newsletter so if you have any suspicions that fraudulent activity may be occurring, please report this at the earliest opportunity.
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We will ensure the NHS is equipped to take proactive action to prevent future losses from occurring.
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When we know that fraud has occurred, we are equipped to respond .
We can assure our key partners, stakeholders and the public that the overall response to fraud across the NHS is robust.
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New Year, New Scams: What could be in store for us in 2025?
As we step into 2025, the landscape of fraud and scams continues to evolve, presenting new challenges for both individuals and organisations. While technological advancements offer increased convenience and connectivity, they also provide sophisticated tools for fraudsters to exploit. This year, we can expect to see a range of innovative scams emerging, blending cutting- edge technology with tried- and-true deception tactics, so lets take a look at some of these emerging scams and how we can spot them.
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Spear-Phishing Spear phishing is a sophisticated scam technique where fraudsters craft highly personalised messages using information they’ve collected about you. This information can come from various sources, including data breaches that have exposed your personal details and public social media profiles where you’ve shared information. By piecing together these bits of data, scammers can build a detailed profile of their target. They then use this information to create messages that appear highly credible, often including your full name, address, date of birth and details about your workplace. The inclusion of such specific personal information makes these messages seem much more legitimate, increasing the likelihood that you’ll trust and respond to them.
AI Generated Images and Videos AI-generated images and videos have become powerful tools for fraudsters, enabling the creation of highly convincing visual content for various scams. These technologies are being exploited to create fake profiles and identities, fabricate product images for online shopping scams, manipulate evidence for insurance fraud, generate misleading charity campaign materials, and produce deceptive content for investment schemes. The hyper-realistic nature of these AI-generated visuals makes it increasingly difficult for people to distinguish between authentic and fraudulent content, posing significant risks across multiple sectors. To protect yourself from AI-generated image and video scams, it’s crucial to approach online content with scepticism and verify information through official channels. In addition:
WhatsApp Scams WhatsApp scams have continued to evolve in recent years, with fraudsters employing various tactics to deceive users. Common red flags include:
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Messages with spelling or grammar errors
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Requests to click links or download apps
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Solicitations for personal data or money
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Impersonation of known contacts
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Offers related to lotteries, jobs, or investments
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Attempts to build trust before requesting sensitive information
These scams typically involve phishing attempts, encouraging users to click on
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Be wary of unusual details in images or videos, especially those related to financial transactions or personal information requests. Unusual details could include blurry areas of the image or strange features, particularly around hands, eyes and background objects. Use reverse image searches to check the authenticity of profile pictures or product images.
To protect yourself from spear phishing attempts:
suspicious links, enter personal information on fraudulent websites, or transfer money to scammers’ accounts. The effectiveness of these schemes often relies on exploiting trust, as messages may appear to come from contacts in the victim’s list, lowering their guard against potential threats. Recently, scammers have started making voice calls via WhatsApp to try to convince the user that what they are saying is genuine. These calls are typically made at a time of the day when the user is likely to be busy, such as during the morning school run, with the aim of making the user feel rushed and flustered, increasing the chances that they will give out personal information.
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Adjust your social media privacy settings to limit public access to your personal information.
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Be cautious about entering personal details on unfamiliar websites.
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Use the website haveibeenpwned.com to check if your data has been compromised in known data breaches.
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Stay informed about the latest deepfake detection tools and techniques.
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Always verify the source of any visual content, particularly when it’s linked to financial decisions or sharing sensitive information.
To protect yourself:
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Be cautious of suspicious messages, especially from unknown contacts
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Verify the identity of unfamiliar senders
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Avoid opening suspicious links or files
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Refrain from forwarding unverified information
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Use the app’s reporting and blocking features when necessary
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Remember that WhatsApp is free and never requires payment
WhatsApp provides tools to help users identify potential scams, such as indicators for messages from non-contacts and information about the sender’s country of registration.
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Case Study 01
Former NHS Neonatal Manager Sentenced to Five Years for £250,000 Fraud
A former NHS neonatal manager has been sentenced to five years in prison for defrauding the NHS of nearly £250,000. The individual was found guilty of nine counts at Cardiff Crown Court in July 2024, following a five-week trial.
Charges and Conviction
Case Background The case began in February 2020, when the individual was suspended from their position as Ward Manager on the Neonatal Unit of the hospital they were employed at, due to allegations of theft and concerns about their qualifications. An internal investigation by the Health Board led to the matter being reported to the Counter Fraud Office in December 2020. The investigation revealed that the individual had created and submitted fraudulent material to secure significant positions of trust within the NHS. They were arrested in April 2021, and were interviewed six times over a six-month period, consistently denying the allegations. Legal Proceedings The individual was formally charged in June 2023, and maintained their not guilty plea through three court hearings between July 2023 and April 2024. Following their conviction in July 2024, they received a five-year prison sentence in October 2024.
Aftermath The Lead Local Counter Fraud Specialist stated that the individual had manipulated and deceived their employers, friends, and colleagues about their qualifications, experience, and alleged military career over many years. The case is intended to demonstrate that individuals who commit fraud against the NHS will face appropriate legal consequences. A Proceeds of Crime Act (POCA) 2002 investigation has been initiated by the investigating Local Counter Fraud Specialists, with assistance from the NHS Counter Fraud Service and the Crown Prosecution Service.
The individual was convicted of:
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Five counts of fraud by false representation
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Two counts of using a false instrument with intent
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One count of unauthorized computer access with intent to commit other offences
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One count of possessing/controlling articles for use in fraud
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Case Study 02
Former NHS Nurse Receives Suspended Sentence for £300 Fraud
A former NHS nurse has been given a 12-month suspended sentence for defrauding the NHS out of £300. The individual appeared in Court in November 2024 after pleading guilty to five counts in August 2024.
Charges and Conviction
Case Background In March 2023, concerns were raised at the Hospital the individual was employed at, regarding missing drugs liable to misuse from three wards. An investigation by the Health Board led to them being interviewed in December 2023, where they denied all allegations. In January 2024, the Health Board and Local Counter Fraud Specialist (LCFS) received reports of stolen prescriptions being presented at several pharmacies in the area during the month. The LCFS promptly conducted enquiries, securing evidence including CCTV footage and photographic evidence of the individual’s fraudulent actions. Legal Proceedings The individual was interviewed in February 2024, on suspicion of fraud by false representation and theft, during which they formally admitted to the offences. They were charged with five offences in July 2024.
In August 2024, they pleaded guilty to all five counts at Court and they received a suspended sentence in November 2024.
The individual pleaded guilty to:
Sentence and Aftermath
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Three counts of making a false instrument
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Two counts of theft
The individual was sentenced to:
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12 months imprisonment, suspended for 18 months
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12-month Mental Health Order
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150 hours of unpaid work
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15 days of rehabilitation
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Cost orders were also awarded.
The Nursing and Midwifery Council (NMC) is now conducting its own investigation and will consider the court’s findings at the next regulatory hearing.
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NHSCFA Strategic Intelligence Assessment 2024
The NHS Counter Fraud Authority’s latest Strategic Intelligence Assessment (SIA) reveals that an estimated £1.316 billion of NHS funds is vulnerable to fraud, bribery, and corruption. This amount represents 0.77% of the NHS budget for 2023-2024, marking a decrease in percentage terms compared to the previous fiscal year 2022-2023.
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The assessment offers a comprehensive analysis of fraud, bribery, and corruption affecting the NHS in England.
It includes:
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An evaluation of potential threats, vulnerabilities, and factors that enable fraudulent activities Data on reported incidents of alleged fraud, bribery, and corruption targeting the NHS in England A calculation of the estimated NHS funds at risk of being lost due to fraudulent, corrupt, or bribery-related activities
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The estimated amount vulnerable to fraud, bribery, and corruption has increased by £50.6 million this year, partly due to the overall growth in the NHS budget. However, when viewed as a percentage of the total NHS budget for 2023-24, the proportion at risk has actually decreased compared to 2022-23. This reduction may be attributed to enhanced counter-fraud measures, such as the ongoing implementation of Real Time Exemption Checking (RTEC) and improved collaboration with stakeholders.
About 86% of the estimated vulnerable funds were associated with four main areas:
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Fraud committed by NHS staff
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Patient exemption fraud
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Procurement and commissioning fraud
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Fraudulent access to NHS care by overseas visitors
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NHSCFA Strategic Intelligence Assessment 2024, continued...
NHS Staff Fraud NHS staff fraud remains the most
Patient Exemption Fraud Patient exemption fraud has emerged as the second most reported category, with 1,404 cases, marking a 61% increase from the previous year. This significant rise is attributed to two main factors:
Fraudulent Access to NHS Care from Overseas Visitors
frequently reported category, accounting for approximately 46% of all reports received by the NHSCFA in 2023-2024, with 2,963 cases reported. This area has seen continued growth in reporting over the past three years, partly influenced by the pandemic and the ongoing cost-of-living crisis.
Reports of fraudulent access to NHS care by overseas visitors accounted for about 6% of all cases received by the NHSCFA in 2023-2024. This category has seen a significant increase, with reports rising by 36% compared to the previous year. This uptick suggests a growing concern regarding the misuse of NHS services by individuals not entitled to free care in the UK. In conclusion, while the NHS has made strides in combating fraud, the fight against financial misconduct remains crucial. To build on this progress, the NHS must continue to enhance its counter-fraud measures, including expanding technological solutions, strengthening staff training, and fostering closer collaboration with stakeholders. By maintaining vigilance and adapting strategies to address evolving fraud risks, the NHS can better safeguard its resources, ensuring that more funds are directed towards patient care and essential healthcare services. If you have any suspicions or concerns about fraud, bribery or corruption affecting the NHS, report it anonymously to the NHS Counter Fraud Authority.
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Misdirected COVID-19 and seasonal influenza vaccination letters:
Reported fraudulent activities by staff included:
Nearly 37% of reports involved incorrect patient registration details and potential identity theft, many of which likely stemmed from errors where vaccination letters were incorrectly sent to wrong addresses.
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Working while on sick leave
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Engaging in other employment during contracted NHS hours
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Prescription misuse:
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Inflating income through false claims for unworked hours and services
28% of all reports in this category related to prescription fraud. The majority of these cases involved prescriptions being obtained by individuals other than the intended patients. Procurement and Commissioning Fraud Reports of procurement and commissioning fraud have risen from 648 to 723 cases, despite a significant decrease in COVID-19 related scam reports. This increase may be attributed to heightened awareness resulting from NHSCFA interventions, such as the distribution of fraud reference guides and the implementation of a priority project. A notable 30% of the procurement and commissioning reports were associated with mandate fraud. This category includes cases where funds were successfully prevented from being diverted and the scam attempts were ultimately unsuccessful.
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Submitting fraudulent expense claims
Additional reports highlighted:
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False representation to secure employment
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Nepotism in recruitment practices by senior staff
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Unauthorised pay band increases for specific shifts and services
cfa.nhs.uk/reportfraud
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Abuse of position or misuse of NHS assets
0800 028 4060
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Collusion among staff members
For more information on NHS fraud, visit cfa.nhs.uk
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New Guidance Released for Corporate Fraud Prevention Offence
The government has published new guidance on the corporate criminal offence of ‘failure to prevent fraud’, introduced as part of the Economic Crime and Corporate Transparency Act (ECCT). This offence aims to hold large organisations accountable if they benefit from fraud committed by their employees, agents, subsidiaries, or other associated persons.
Key Points of the New Offence
Implementation and Scope The offence will come into force on 1
Broader Context Fraud continues to be the most prevalent crime in the UK, accounting for approximately 40% of all reported offenses in England and Wales. The government’s introduction of new anti-fraud measures is part of a broader strategy aimed at curbing fraudulent activities and safeguarding potential victims, including both individuals and businesses. The new offence aims to encourage organisations to build an anti-fraud culture, similar to how the failure to prevent bribery legislation has reshaped corporate culture since its introduction in 2010.
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Applies to large, incorporated bodies, subsidiaries, partnerships, and incorporated not-for-profit organisations like charities Organisations may be held criminally liable if an associated person commits fraud for the organisation’s benefit Prosecution requires the organisation to demonstrate reasonable fraud prevention measures were in place
September 2025. It covers various fraudulent activities, including dishonest sales practices, concealment of important information from consumers or investors, and dishonest practices in financial markets. If prosecuted, the organisation must prove to the court that it had implemented adequate fraud prevention measures when the fraudulent activity occurred. Guidance Development The guidance was developed collaboratively with input from several government bodies and agencies, including:
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Crown Prosecution Service (CPS)
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Serious Fraud Office (SFO)
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HM Treasury
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HMRC
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Ministry of Justice
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Cabinet Office
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Attorney General’s Office
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Financial Conduct Authority (FCA)
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Reporting Fraud
Everyone has a part to play in fighting fraud. If you work for the NHS and suspect any fraud, bribery, or corruption against the NHS, please contact your Local Counter Fraud Specialist. Alternatively, please contact the NHSCFA 24-hour reporting line by calling 0800 028 4060 , or by completing the online reporting form. All reports are treated in confidence, and you have the option to remain anonymous.
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