Total annual expenditure for this area has increased by approximately £800 million compared to 2018-19, totalling £9.9 billion.

For agency expenditure, NHSCFA has previously identified through loss analysis exercises that the likely rate of overcharging associated with employment agency staff invoicing is 4.7% of which the NHSCFA has taken the view that 50% of overcharging may be vulnerable.

£267.7m

from an expenditure of £9.9 billion

The NHS is vulnerable to patient fraud in three key areas:

  • Prescription charge evasion; with an estimated NHS expenditure of £8.6 billion. Financial fraud vulnerability: £193 million.
  • Dental charge evasion; with an estimated NHS expenditure of £815 million. Financial fraud vulnerability: £33.8 million.
  • Optical voucher abuse; with an estimated NHS expenditure of £528 million. Financial fraud vulnerability: £40.9 million .

(The individual fraud vulnerability rates were applied to each exemption category in order to assess the overall vulnerability)

NHSBSA data is demonstrating positive results for this area, in that mis-claimed treatment/prescriptions appear less prevalent; becoming more of a consistent trend. An increase in views for NHSBSA’s exemption checker since 2019 and positive campaigns encouraging personal responsibility with exemption entitlement, like the ‘check before you tick’, also appears to be having an impact.

Information reports received for patient fraud

Change in the number of fraud referrals (allegations) received in relation to patient fraud from 2016-17 to 2019-20.

22%

decrease in referrals for this theme compared to last year

2016-17 2017-18 2018-19 2019-20
1,104 2,160 1,575 1,228