How NHS Counter Fraud Authority
protects the NHS with Clue

The NHS is vulnerable to £1.14 billion worth of fraud each year, according to its latest estimate.

NHS Counter Fraud Authority’s (NHSCFA) purpose is to prevent this misappropriation of NHS resources and, in doing so, protect the capabilities of frontline staff to save lives.

FIGHTING FRAUD IN HEALTHCARE

The vast majority of those who use, work in, or interact with the NHS are honest. But there is a small minority who commit fraud against the public healthcare system, from patients, members of the public to NHS staff, contractors, and suppliers – even organised crime groups.

Relying heavily on intelligence and investigations, NHSCFA now uses Clue as a central counter fraud case management system.

The NHSCFA relies on Clue to serve 400+ organisations, 200+ counter fraud champions and 254 local counter fraud specialists (LCFSs) within the NHS counter fraud community across England and Wales.

IMPLEMENTING CLUE DURING THE PANDEMIC

Fraud attempts and incidents targeting healthcare and public sector spiked during the pandemic as criminals sought to exploit the disruption caused to services and an increased reliance on digital.

As frontline NHS staff battled the healthcare aspects of the global pandemic, their NHSCFA colleagues were working to protect them and the budgets that supplied them.

Overcoming national lockdowns, NHSCFA and the wider NHS counter fraud community collaborated to tailor the Clue platform in a way that revolutionised data capture and interrogation for one of the world’s largest employers.

“Our implementation of Clue is a significant success story
for the NHS Counter Fraud community.

“We came together to achieve something that transcends our individual organisations, during a time typified by great insecurity.”

IMPACT OF CLUE

 

  • Since implementing Clue, 2212 fraud incidents have been recorded leading to 586 new investigations, while helping to ensure active cases are supported.
  • Raw data from this activity combined with Clue’s ability to surface and visualise connections between data provides intelligence relating to active cases totalling millions of pounds.
  • New intelligence gathered through Clue has advanced NHSCFA’s proactive counter fraud activity, enabling earlier recognition of warning signs and ability to keep pace with evolving threats.
  • Better enablement of proactive measures has led to the development of best practice in preventative counter fraud strategy among the NHS counter fraud community.
  • NHSCFA’s use of Clue has unified disconnected data across the NHS counter fraud community across England and Wales, providing secure and centralised intelligence.
  • Clue’s standards of interoperability enable the NHSCFA to more seamlessly and securely collaborate with police and Crown Prosecution Service (CPS) to bring offenders to justice.
  • The expansive deployment by NHSCFA across the NHS counter fraud community demonstrates the range and scale of centralised support Clue can provide in counter fraud.

“Our strapline is: Spot it, report it, together we stop it.

“The Clue system embodies this and helps NHSCFA and the NHS counter fraud community identify fraud risks – it supports better reporting and, ultimately, helps us in our work to stop fraud.”