Reciprocal healthcare fraud
Fraud relating to overseas visitors claiming for treatment under reciprocal healthcare agreements when not entitled to do so.
vulnerable from an expenditure of £92.2 million
Reciprocal healthcare encompasses fraudulent use of European Health Insurance Cards (EHICs), Global Health Insurance Cards (GHICs), and various other reciprocal healthcare arrangements. Also, false representation during the application stage for a card or certificate which enables the holder to benefit from a reciprocal healthcare agreement.
The decrease in financial vulnerability this reporting period can be attributed to a more accurate data source used through collaboration with the Department of Health and Social Care. Regardless, the number of claims within the collection period is likely to have been affected by the UK not lifting COVID-19 travel restrictions until March 2022. As a result, it is assessed this will increase in the future as more individuals access reciprocal healthcare.
It is assessed that there is a threat that patients continue to use their EHIC/GHIC after permanently moving abroad, with reliance on the card holder to notify any changes in circumstance. It is also a realistic possibility that patients will claim their application has been submitted earlier to gain access to care without charge.
It is a realistic possibility to produce a fraudulent card, creating confusion over appearance and acceptance, especially as varying versions of the GHIC and the new EHIC are currently in circulation.
As the application is online, it is also a realistic possibility that some applicants will provide forged documentation to prove entitlement. It is also possible that some applicants may falsify eligibility to an EHIC/GHIC or fail to return one they are no longer entitled to. Some NHS staff may assume a patient is entitled to care without charge when they present an EHIC/GHIC, with confusion and/or presumption that the application is valid.
During this reporting period, the NHSCFA received a total of four reports compared to last year’s total of 11. It is assessed this may be linked to a hangover from the various COVID-19 travel restrictions in place over the previous couple of years of reporting.
Since its launch in January 2021, the GHIC has continued to replace the legacy EHIC, and as predicted, GHIC fraud related reports are appearing for reciprocal healthcare.
The change in the number of fraud reports received in relation to reciprocal healthcare from 2018 – 2019 to 2022 – 2023 is illustrated in the below chart:
|2018 to 2019||2019 to 2020||2020 to 2021||2021 to 2022||2022 to 2023|
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