NHS dental services in England are provided by dental practitioners under contract to deliver general care and treatment. Dental contractor fraud concerns the fraudulent claims submitted to the NHS by dentists and their staff members for a range of NHS services provided to patients.
Dental contractors have unique knowledge and understanding of service contracts and repayment mechanisms. This gives them an advantage of understanding the vulnerabilities within the current claims process. Contractors often have complete authority in knowing what treatments a patient needs, and this empowers them to manipulate records either with the cooperation or coercion of staff before invoices are submitted for payment.
£58.6m
vulnerable from an expenditure of £3.124 billion
It is likely that some contractors will change patient treatment data and manipulate patient lists to claim extra funding. Claims can be inflated to secure a higher level of Units of Dental Activity (UDAs) than delivered. This process could be completed solely by the dental practitioner and / or with the collusion of other staff members.
It is likely that some staff unknowingly submit false claims by following the instructions of practitioners or practice managers. These claims can be for treatments or services not delivered or clinically needed.
It is also possible for dentists to receive a double income by submitting false claims to the NHS for patients who have already paid for private treatment or claim that a fee-paying patient is exempt.
It is assessed as likely that some contractors are employing overseas non-UK registered staff to provide certain treatments to patients. Similarly, there are some untrained dental technicians who are being employed to manufacture dental products in non-compliant premises.
Information reports received for dental contractor fraud
The change in the number of fraud reports received in relation to dental contractor fraud from 2019 - 2020 to 2023 - 2024 is illustrated in the chart below:
| 2019 - 2020 | 2020 - 2021 | 2021 - 2022 | 2022 - 2023 | 2023 - 2024 |
|---|---|---|---|---|
| 2019 - 202090 | 2020 - 202191 | 2021 - 202285 | 2022 - 202374 | 2023 - 202463 |
Horizon scanning
In February 2024 the government announced the introduction of the Dental Recovery Reform which included a £200m support package. This includes increasing the minimum value of dental treatment, launching a ‘new patient’ payment to treat around 1 million additional patients, who in the previous 12 months have not seen an NHS dentist, and 2.5 million extra dental appointments over the next year.