vulnerable from an expenditure of £2.4 billion
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.
The COVID-19 pandemic resulted in the suspension of routine
dental treatment, however, contractors continued to receive
payments to the full contract value. These restrictions would
have continued to impact Units of Dental Activity (UDA)
behaviour during 2021 – 2022, and as such, estimated financial vulnerability does not
demonstrate UDAs pre-pandemic. However, for this reporting period, the decrease in
financial vulnerability is assessed due to a reduction in total expenditure and the number of
It has assessed a realistic possibility that some contractors may be encouraged to
fraudulently submit claims to meet or exceed quotas, due to pressure to meet pre-pandemic
activity levels and avoid clawback of funds for underperformance of the contract.
It is likely that some contractors may manipulate activity through altering patient data and
UDAs claimed to secure additional funding. These claims may be for treatments or services
not delivered or clinically needed. Additionally, it is also likely that double income occurs
where claims to the NHS are submitted for patients who have already paid for private
treatment or claims for charge paying patients submitted as exempt.
Practice employees could be complicit in fraudulent practice and conceal for the benefit
of the practice or contract holder. Pressure from contractors or lead practitioners could be
placed on practice staff to endorse fraudulent activity or obey instructions.
There is also potential for patients to act in collusion with dental performers to receive free
or reduced cost treatment, such as the dentist claiming the patient is exempt or accepting a
reduced cash cost. This may extend to unwitting complicity from the public due to a lack of
understanding of how dental treatment and charges should operate.
This reporting period has seen implementation of dental contract reforms including changes
to payment rates and UDA values. This could impact claiming behaviour and financial
vulnerability within this thematic area.
Information reports received for dental contractor fraud
There were 78 reports of dental contractor fraud this reporting period, an 11% decrease from
2021 – 2022. Reporting is at its lowest in the past five years and 28% lower than in 2018 –
2019. Aside from 2020 – 2021, reporting has also decreased annually.
The decrease in reporting levels is assessed linked to the reduction in dental services
provided, as well as the temporary contractual agreements introduced during the pandemic.
However, this may increase once there is an extended period of business as usual beyond
the pandemic restrictions.
The change in the number of fraud reports received in relation to dental contractors from
2018 – 2019 to 2022 – 2023 is illustrated in the below chart:
Table showing the number of fraud reports received in relation to dental contractor fraud from 2018 – 2019 to 2022 – 2023
|2018 to 2019
||2019 to 2020
||2020 to 2021
||2021 to 2022
||2022 to 2023