NHS calls on SAS for anti-fraud initiative

The National Health Service is to unveil plans to develop sophisticated computer systems to tackle losses estimated at more than...

The National Health Service is to unveil plans to develop sophisticated computer systems to tackle losses estimated at more than £1bn a year through fraud by patients, practitioners and NHS suppliers.

The health service is stepping up its fight against fraud following a series of dramatic reductions in dental, pharmaceutical and optical fraud since the creation of the services' Counter Fraud Service two years ago.

The Government is expected to announce tomorrow (Friday) that the NHS has cut losses from fraud by patients by almost 40% - a saving of more than £100m a year since 1999.

But ministers believe this is just the tip of an iceberg. The latest initiative will use advanced IT systems to identify and target fraud by drugs and equipment suppliers, and health practitioners, which account for a far higher proportion of NHS losses than patient fraud.

"We shall be using the most sophisticated technology to target those who would deprive the NHS of the resources it needs for patient care," said health minister, Lord Hunt.

"We aim to learn from every example of fraud so that we continuously improve our capacity to detect and stop it."

The NHS Counter Fraud Service is teaming up with IT software firm SAS to develop systems that will allow the health service to analyse payment records and other data for signs of fraud.

Although many of the data sources needed are currently held on incompatible systems in different parts of the NHS, the Government's £3bn injection of cash for IT will enable it to analysed centrally in future.

The project is expected to bring together a wide variety of data sources that are currently held in different parts of the NHS, into a central data warehouse where they will be trawled for patterns that will indicate fraud.

"We will be trying to look at particular profiles through transactions and behaviours to spot those patterns which are indicative of fraud. It is a proactive approach to give local counter-fraud teams and investigators intelligence to work on," said Peter Dorrington, head of fraud solutions at SAS.

NHS specialists will use techniques such as benchmarking to compare the funding claims of dentists surgeries, or health centres. They will use sophisticated software to identify invoice cramming, or claims that may have been filed at suspicious times of the day, such as on a weekend, or after working hours.

SAS believes that the technology will allow the health service to save tens or hundreds of millions of pounds a year. It will also make the process of identifying fraud much more efficient, said the company.

Under the partnership, SAS will assist the health service to develop software tools for detecting fraud. It will also provide consulting services and training to NHS investigators.

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