Reciprocal healthcare encompasses fraudulent use of European Health Insurance Cards (EHICs), Global Health Insurance Cards (GHICs), Provisional Replacement Certificates (PRCs) and various other reciprocal healthcare arrangements. Also, false representation during the application stage for a card or certificate.
£400,000
vulnerable from an expenditure of £78.2 million
The financial vulnerability estimate has been improved through a continued collaborative approach with policy holders to maintain a more accurate and up-to-date figure. Furthermore, the estimate only encompasses EHIC, GHIC and PRC expenditure, it does not include the S1k scheme, the smaller S2l scheme or other reciprocal healthcare agreements.
It is possible for an individual without exemptions to be provided with UK insured healthcare through an EHIC / GHIC (instead of through an S1) whilst permanently residing outside the UK. It is a realistic possibility that some applicants may use a false UK address and request associates forward the card on to them.
It is also likely that some individuals, although eligible at the time of application, will fail to declare their change in circumstances when they move abroad permanently and will continue to use their UK issued EHIC / GHIC, including for planned care, instead of applying for an S1, or upon refusal of an S2.
When the UK claims for the costs of the NHS treating European Union (EU) / European Free Trade Association (EFTA) insured individuals, it is highly likely that some invoices will be rejected by a member state due to fraud or error. For example, the rejection of an invoice based on a patient not being insured for any or all of the treatment they received. This is reported to occur when an individual retrospectively applies for a card once care has begun instead of a PRC, therefore the invoice may not be rejected until the claim is reviewed.
Information reports received for reciprocal healthcare fraud
The change in the number of fraud reports received in relation to reciprocal healthcare from 2019 - 2020 to 2023 - 2024 is illustrated in the chart below:
| 2019 - 2020 | 2020 - 2021 | 2021 - 2022 | 2022 - 2023 | 2023 - 2024 |
|---|---|---|---|---|
| 2019 - 202011 | 2020 - 202121 | 2021 - 202211 | 2022 - 20234 | 2023 - 20247 |
Horizon scanning
In January 2024 the UK-European Economic Area (EEA) EFTA Social Security Coordination Convention came into force and in October 2023 the UK-Switzerland Social Security Coordination Convention was fully introduced. These changes have not yet been implemented for a full year and therefore it is possible that fraud reporting and the amount financially vulnerable would likely increase.
- Provides healthcare to eligible individuals living in an EU or EFTA country and constitutes the majority of reciprocal healthcare expenditure
- Provides planned treatment in EU or EFTA countries for UK residents.