The new NHS Counter Fraud Authority believes the health service is losing more than half a billion pounds in likely but uncorroborated fraud.
The new statutory body, whose power became active today, has released a document setting out the scale of potential NHS losses from fraud.
It said £216m in fraud was “almost certain” and a further £135m was “highly likely”.
The CFA said £560m as “likely”, which it defined as intelligence in which it had “moderate confidence – when the information is open to various interpretations or is credible or plausible, but lacks corroboration”.
Of this, £100m was pharmaceutical contract fraud, £90.6m was payroll and identity fraud and £165m was procurement and commissioning fraud.
The total cost of fraud to the NHS reaches £1.25bn if fraud considered a “realistic probability” is included, which totals £338.5m.
The authority defines this estimate as something in which it has “low confidence – where information is scant, or very fragmentary, or when sources are of dubious reliability”.
HSJ reported earlier this year that the number of successful fraud prosecutions had declined by three-quarters over the past six years.
The CFA replaces NHS Protect, which was part of the NHS Business Services Authority.
NHS trusts, foundation trusts and clinical commissioning groups are responsible for their own counter-fraud arrangements and are expected to bring cases locally.
A training centre run by NHS Protect closed earlier this year.