Ahead of the NHS Fraud conference this month, we caught up with four of our speakers to get their opinions on the future of counter fraud within the healthcare sector, and their top advice for other counter fraud professionals.
What will the biggest fraud threats be for the NHS in the next 6-12 months?
"If I was to generalise the pressure points on fraud risk I would point to the current pressures on the cost of living and the increase in cyber enabled crime. Over the next 6-12 months this is unlikely to change. The New Hospitals Programme (NHP) funded by DHSC and rolled out to specific trusts will be an area that will require robust counter fraud measures set. Those Trusts selected for the programme should ensure they have early input from their counter fraud team to ensure appropriate counter fraud measures are adopted and managed throughout the programme duration. This would include assessing the risks that may affect the programme."
"I think the biggest fraud threats will be insider (employee) fraud. The current economic climate is driving many to go to desperate measures to stay afloat and, if this isn't done through legal means, economic crime is the next best alternative."
Claire Maillet
PhD Researcher, University of Portsmouth
Director of Financial Crime Operations, Ziglu
"The continued use of technology and ensuring that systems are robust to prevent and identify fraud."
Simon Hammond
Director of Claims Management
NHS Resolution
"From my perspective Insider Threat is high on the agenda because working from home has raised more opportunities for fraud to happen. According to the newly released Fraudscape 2023 by Cifas, the highest ever volume of identity fraud cases was recorded in 2022 – over 277,000 cases. This is up by nearly a quarter – 23% – on 2021 and accounts for 68% of all cases on the NFD.
The other area I would add is Procurement and Commissioning, where there are more and more contracts being let and transparency and integrity are key."
Rachael Tiffen
Director of Public Sector
Cifas
What do you think is key when it comes to dealing with fraud?
"High quality fraud risk assessment should be at the centre of developing a counter fraud strategy. A detailed understanding of an organisations fraud risk forms the foundations of developing resource and workstreams to mitigate those fraud risks and protect the public purse. Every pound prevented from being lost to fraud is a pound that can be spent on patient care."
"I think the key to dealing with fraud is having access to real-time, high quality and clean data. Fighting fraud is losing battle without the data to back up internal proposals, decisioning and monitoring."
Claire Maillet
PhD Researcher, University of Portsmouth
Director of Financial Crime Operations, Ziglu
"Robust systems to identify potential fraud threats when planning new activity, having fraud and how it interacts with business processes at the forefront of the mind."
Simon Hammond
Director of Claims Management
NHS Resolution
Jessica Kimbell, GovNet
