Optical contractor fraud involves submitting claims to the NHS for optical treatments, services, or enhancements not delivered or clinically required.
The decrease in the amount financially vulnerable to fraud bribery and corruption can be attributed to a decrease in expenditure.
£90.7m
vulnerable from an expenditure of £564.5 million
There is the possibility that contractors are prescribing spectacles to vulnerable care home residents and children without consulting their next of kin. Including not performing a genuine eye test on care home residents and claiming for two pairs of spectacles. Potentially occurring when there is reduced oversight.
Submission of fraudulent General Ophthalmic Services (GOS) 1, 2 and 3n claims for ghost patients, or patients who did not require NHS services or treatment, or never attended for eye tests or spectacles is likely. False GOS claims for patient services which were not provided or clinically required was also identified, in addition, manipulation of prescriptions to claim for higher value GOS payments, double claiming for appointments by splitting treatments or submitting multiple claims for the same voucher was also noted.
There is the potential for ophthalmologists to charge eligible patients and simultaneously submit a GOS claim for the same service, or charge extra on top of the GOS vouchers for financial gain. Additionally, there is the potential for ophthalmologists to be claiming reimbursements from the NHS for private patients, or those who are ineligible for free NHS eye tests or vouchers.
Use of false or fraudulent signatures to submit GOS claims is a realistic possibility. There is the potential for an optical branch to use the signatures of practitioners who are no longer employed by the practice for GOS forms or to submit false claims for those exempt from charge with fraudulent signatures.
An emerging threat included Optical practices which did not hold an NHS contract submitting their claims through a practice in another area which does hold an NHS contract. Potentially enabled through staff at the practice altering the claims or collusion.
The International Council of Ophthalmology (ICO) certificate is given to successful candidates who pass the ICO Advanced Examination. However, there is a realistic possibility that an applicant could submit false documentation to an ICB when applying for a contract to provide GOS.
An ophthalmology consultant could perform private work in a private hospital yet issue FP10o prescriptions to private patients. Also in secondary care, there is a remote chance that a patient could pay for an item which was not provided, with no payment record appearing on the hospitals financial system.
Information reports received for optical contractor fraud
The change in the number of fraud reports received in relation to optical contractor fraud from 2020 - 2021 to 2024 - 2025 is illustrated in the below chart:
| 2020 - 2021 | 2021 - 2022 | 2022 - 2023 | 2023 - 2024 | 2024 - 2025 |
|---|---|---|---|---|
| 2020 - 202111 | 2021 - 202224 | 2022 - 202322 | 2023 - 202428 | 2024 - 202541 |
Horizon scanning
The media has reported on the introduction of 10% tariffs on UK imports to the USA, this could indirectly affect NHS optical services. While medicines are currently exempt from tax at the time of writing this assessment, some medical equipment and supplies used in NHS optical services may become more expensive. Future costs of treatment may also increase due to increased cost in the supply chain. This could potentially lead to higher prices for optical equipment and delays in services.
- NHS optical vouchers help eligible patients cover the cost of spectacles or contact lenses.
- An FP10 is a prescription form