The Report

From false invoices to 'rigged' waiting lists, here is the list of frauds and abuses in healthcare

The map of risks in the National Health Service as a lever to enhance transparency, reduce waste and promote fairness of care in an area that as certified by Anac 'cubes' 70.5 billion in public contracts

by Barbara Gobbi

19 May 2026

5' min read

Translated by AI

Versione italiana

5' min read

Translated by AI

Versione italiana

From 'undue influence on healthcare activities' in healthcare governance to biased reporting in research. From the misuse of post-marketing studies in the promotion of drugs and devices to the improper certification of professional qualifications. From collusion between participants in tenders for the purchase of goods and services to the re-labelling of products. From false invoicing to abusive practices to favouritism and the diversion of patients to private facilities.

As many as 65 types of fraud and abuse fall into nine areas in the first 'taxonomy' of offences and anomalies in healthcare that the Gimbe Foundation proposes to adopt, in order to standardise language, classifications and monitoring criteria. The proposal is contained in the Report of the Gimbe Observatory 'Fraud and Abuse in Healthcare', presented by its president Nino Cartabellotta at the headquarters of Anac, the National Anti-Corruption Authority, with which it has a memorandum of understanding in place.

Ssn dish "greedy"

The assumption is that fraud and abuse in healthcare are not isolated episodes but 'systemic distortions that run through the entire chain of the National Health Service'. And if in all countries the health sector is a vulnerable one, Italia would present particularly favourable ground, with its score of 53 out of 100 in the Transparency International Corruptio Perceptions Index 2025, which places it in 19th place among the EU Paresi and 52nd globally, worsening compared to the previous year.

The health dish is rich and 'greedy' for possible opacity or malfeasance: the Anac estimated in 2023 that 25% of the total value of public contracts, amounting to 70.5 billion, concerns precisely the assignments in these areas for drugs, medical devices, health equipment and non-health services from cleaning to catering to surveillance. "This figure," comments Nino Cartabellotta, President of the Gimbe Foundation, "although it does not allow us to accurately estimate the economic impact of corrupt practices, it does indicate the extent of the area of public spending most exposed to corrupt practices. It is precisely here that more transparency, digital traceability, timely controls and accountability are needed'.

The taxonomy

The Gimbe taxonomy is divided into nine areas: policy-making and governance of the health system, regulation of the health system, clinical research, marketing and promotion of drugs, medical devices and other health technologies, purchase of goods and services, distribution and storage of health products, management of financial resources, management of human resources, and delivery of health services. "Faced with the extreme variability of corrupt practices and the fragmentation of terminology - states Cartabellotta - a shared taxonomy is not an exercise classificatory, but an operative tool: it serves to speak the same language, measure risks, compare data, orient controls, plan and make prevention policies assessable. For the Foundation, today it is indeed necessary to move from a predominantly reactive model to a preventive one, starting with the standardisation of terminology and the adoption of the shared taxonomy of fraud and abuse in healthcare.

Other operational proposals include the establishment of a National Observatory on Fraud and Abuse in Health Care capable of integrating health, administrative and judicial information flows, the strengthening of the predictive capacity of controls through risk indicators and artificial intelligence tools, a more rigorous and transparent management of conflicts of interest, the protection and enhancement of whistleblowing as an intelligence tool, the strengthening of internal audits and accountability of health care companies. These proposals include the establishment of a National Observatory on Fraud and Abuse in Health Care capable of integrating health, administrative and judicial information flows, the strengthening of the predictive capacity of controls through risk indicators and artificial intelligence tools, a more rigorous and transparent management of conflicts of interest, the protection and enhancement of whistleblowing as an intelligence tool, the strengthening of internal audits and accountability of health care companies

More abuse, more inequality

According to Cartabellotta, "fraud and abuses in healthcare do not only take away economic resources, but they undermine the quality and safety of care, worsen the accessibility of services and fuel distrust in institutions. And they affect above all the most fragile segments of the population, widening inequalities social and territorial. The international scientific literature documents, particularly in low- and middle-income countries, correlations between high levels of corruption andincreased infant and child mortality, reducedlife expectancy and worsened well-beingperceived, they finally warn from the Foundation. "When a service is passed over not because of clinical need, but because of money, relationships or interests," Cartabellotta warns, "it does not just create a fast track: it subverts the principle that should guide the SSN, i.e. treating first those who need it most

Current administration "gateway"

"In the health sector, maladministration is the first opening through which criminal infiltration, waste, and distortions creep in," warns Anac president Giuseppe Busia. Not only crime, but also mismanagement: anomalies in tenders, irregularities in waiting lists, favouritism in appointments, opaque accreditations. Conduct that does not always constitute a crime, but which diverts resources and compromises the fairness of the system. Often underlying these are unmanaged conflicts of interest and insufficient transparency. This is why Anac,' Busia goes on to explain, 'has been devoting special attention to healthcare for years, analysing its specific risks and indicating targeted prevention measures. The 2015 National Anti-Corruption Plan and the 2016 update have already delved into the main critical issues, and in 2017 we adopted guidelines dedicated to the SSN codes of conduct. Today, for each risk area, we are proposing operational measures that will be subject to public consultation: we want shared, applicable and truly useful solutions. Prevention only works if it is participatory, transparent and verifiable.

Most Exposed Public Contracts

The area most exposed to corruptive risks and mismanagement,' the president of Anac continues, 'remains that of public contracts, where the coincidence between those who propose the purchase and those who use drugs and devices can generate opacity, non-competitive choices, and room for criminal infiltration, with unjustified direct awards, non-transparent procedures, and exceptions due to inadequate planning. Anac has therefore defined targeted prevention measures'.

Virtuous Digital Transparency

"Digitisation and transparency," Busia continues, "are not fulfilments, but levers of efficiency and guarantees of fairness. Making contracts, data, and processes digital native means simplifying work, reducing burdens, speeding up controls, and strengthening the system's capacity to prevent abuse. Digital transparency does not slow down: it is a multiplier of quality, participation and trust. In healthcare, then, it is decisive in making citizens truly aware of how to access services and in fully implementing the principles of equality and universality of the NHS. For this reason, it is necessary to extend the publicity of data,' he warns, 'even beyond the legal obligations, when it serves to ensure widespread control and effective knowledge of public performance'. The president of Anac then emphasises that 'in healthcare contracts, the qualification and specialisation of contracting stations' are 'essential'.

Protecting SSN excellence

Finally, the necessary clarification: 'It is essential, however, to prevent the misconduct of a few from overshadowing the meritorious - often heroic - work of the vast majority of healthcare personnel. Our SSN remains an internationally recognised model of excellence and for this very reason it must be protected with determination, strengthening integrity, transparency and accountability. Defending public healthcare from corruption and mismanagement means defending people's lives,' concluded the president of Anac.