Patient exemption fraud

Obtaining prescription or other controlled medication with the intention of onward trading for profit remains highly likely, particularly around pain-relieving medication which can be recreationally misused. These items are commonly obtained through deception with the direct intention of onward trade, or through trading unused, or unwanted prescriptions. They often end up in the hands of criminal groups and further sold in lucrative markets in the UK and abroad.

Evading NHS charges, particularly prescription charges, is also prominent within this thematic area. Although genuine errors can occur, the expansion and widespread use of RTEC in pharmacies is helping to reduce erroneous or incorrect claiming, with a majority of pharmacies actively using the system in England. It is a realistic possibility that offenders will exploit the NHS Low Income Scheme (LIS), a means tested certificate allowing exemption from NHS charges, by providing false information to obtain an exemption.

The use of another patient’s identity or address to access NHS services, particularly medication or to evade charges, is assessed as a threat in this area. Individuals who may be in the country illegally will likely do this to avoid detection from other authorities, or because of the common misconception they are not entitled to primary care in the NHS, which further enables this type of fraud.

Information reports received for patient exemption fraud

Horizon scanning

In October 2023, a media group reported that thousands of COVID-19 and seasonal influenza vaccination letters were reported to have been erroneously sent to incorrect patient addresses. As a result, personal information could be harvested or identities stolen to access NHS services.