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| NHS Counter Fraud Authority | |
|---|---|
| Agency name | NHS Counter Fraud Authority |
| Formed | 2017 |
| Preceding1 | NHS Protect |
| Jurisdiction | England |
| Headquarters | London |
| Employees | Approx. 500 |
| Parent agency | Department of Health and Social Care |
NHS Counter Fraud Authority is the statutory body charged with leading counter-fraud, bribery and corruption work across the National Health Service in England. It was established to provide national direction on loss prevention, harm reduction and criminal investigation in health services, replacing earlier arrangements and aligning with ministers, regulators and law enforcement. The organisation operates at the intersection of public sector oversight, regulatory frameworks and criminal justice responses to fraud affecting health care delivery.
The authority was created following policy decisions by the Department of Health and Social Care and legislative instruments embedding specialist counter-fraud functions formerly performed by NHS Protect and predecessor units from the NHS Counters Fraud and Compliance era. Its formation was influenced by reviews associated with Care Quality Commission inspection regimes, public inquiries such as the Francis Inquiry into Mid Staffordshire NHS Foundation Trust failures, and national anti-fraud strategies shaped after collaborations with the Crown Prosecution Service, National Crime Agency, and local Serious Fraud Office practices. Early years saw establishment of statutory powers, recruitment of specialist investigators often drawn from Metropolitan Police Service, City of London Police, and local authority fraud teams, and alignment with the Cabinet Office anti-corruption agenda.
The authority is governed by a board comprising non-executive members and executive directors, accountable to ministers at the Department of Health and Social Care. Corporate leadership includes roles interacting with the National Audit Office, Public Accounts Committee, and arm’s-length bodies such as NHS England and Health Education England. Operational divisions align with functions like intelligence, investigations, assurance, policy and legal services; senior staff often have prior service in the Crown Prosecution Service, National Policing Improvement Agency predecessors, and regional enforcement partners including Police and Crime Commissioners. Governance frameworks reference statutory instruments and oversight from parliamentary select committees including the Health and Social Care Select Committee.
The authority’s remit encompasses prevention, detection, investigation and prosecution referral of fraud, bribery and corruption affecting NHS resources. Powers include information gathering, civil recovery support and coordination of criminal investigations in liaison with prosecuting authorities such as the Crown Prosecution Service and the Independent Office for Police Conduct where appropriate. It provides national counter-fraud standards, fraud loss measurement methodologies and guidance used by NHS Trusts, Clinical Commissioning Groups, Integrated Care Boards, and arm’s-length bodies to meet statutory duty of stewardship. Legal tools draw on legislation such as the Proceeds of Crime Act 2002 and offences under the Fraud Act 2006 when preparing cases for charging decisions by prosecuting authorities.
Operational activity includes fraud risk assessments, intelligence-led tasking, data analytics collaborations with bodies like NHS Digital and the Government Digital Service, proactive exercises on procurement fraud, payroll fraud, and patient fraud, and national awareness campaigns coordinated with Fraud Advisory Panel stakeholders. It publishes guidance materials, anti-fraud e-learning for staff deployed across NHS Trusts and independent sector providers, and runs national campaigns alongside organisations such as Action Fraud and the Anti-Corruption Alliance. Operational liaison occurs with law enforcement units including the National Crime Agency and regional police economic crime units for joint operations and training.
The authority has supported investigations into a range of schemes: false invoice and procurement frauds involving private contractors, payroll and recruitment frauds within trusts, and patient identity and prescription frauds linked to organised networks. Cases have resulted in civil recoveries and criminal prosecutions undertaken by the Crown Prosecution Service in partnership with regional CPS Economic Crime Unit teams and police forces including the Greater Manchester Police and the West Midlands Police. High-profile inquiries often interface with regulatory action by the Care Quality Commission and employment tribunals, and occasionally feed into parliamentary questions and select committee hearings.
Performance measurement uses metrics reported to the Department of Health and Social Care and scrutinised by the National Audit Office and the Public Accounts Committee. The authority has been evaluated for effectiveness in reducing loss, timeliness of investigations, and value-for-money; critiques have come from NHS bodies and parliamentary scrutiny for perceived delays, resource constraints, and challenges in quantifying prevented losses. Academic and policy commentators, including contributors from King’s College London and University College London research units, have highlighted tensions between centralised enforcement and local assurance capacity in NHS Trusts and Integrated Care Systems.
The authority maintains formal and informal partnerships with law enforcement agencies such as the National Crime Agency, the Crown Prosecution Service, regional economic crime units, and anti-fraud organisations including the Fraud Advisory Panel and Association of Certified Fraud Examiners. It works closely with regulatory and commissioning bodies like NHS England, Care Quality Commission, and NHS Digital, and engages with international networks on health fraud through entities connected to the Organisation for Economic Co-operation and Development and cross-border law enforcement forums. These partnerships underpin joint operations, training, information sharing, and development of counter-fraud standards used across health service providers.
Category:Health agencies of England