In this Insight Briefing, we provide a summarised overview of the referrals received by our Anti-Fraud & Investigations Team from 2021/22 to 2023/24. This report specifically covers the 34 clients that we support with anti-fraud and investigation services.

Key Messages

The primary aim of this briefing is to provide insight into the nature of the referrals we received during the review period and their subsequent outcomes. It is important to note that not all referrals result in full investigations in accordance with criminal law requirements. Furthermore, even those that do progress to investigations do not always lead to criminal sanctions or successful financial redress.

A follow-up Insight Briefing will dive deeper into our investigation casework. However, we believe it’s useful to start by analysing the referral process, including:

• The volume of referrals received
• The general nature of the cases
• The sources of those referrals
• The outcomes, and the factors influencing those outcomes

Referral Assessment Process

Some referrals are straightforward and require just an hour or two of consideration. Others may demand more extensive probing—sometimes taking days or longer—especially when additional information from other parties is required. Each referral is thoroughly assessed before any next steps are determined.

While we cannot address every case in this briefing, our goal is to spark a broader discussion on the nature of NHS fraud referrals, how we address them, and how they relate to the national picture.

We hope this overview proves helpful in understanding the complexities of fraud cases within the NHS and the critical role that our team plays in addressing these challenges.

By providing this summary, we aim to give stakeholders a clearer picture of how fraud referrals are managed and the realities of investigations within the NHS context.

Download Analysis of MIAA Fraud Referrals