Reciprocal healthcare

Fraud relating to overseas visitors claiming for treatment under reciprocal healthcare agreements when not entitled to do so.

It is estimated that the NHS spent £72.5 million treating individuals with EHIC cards issued abroad between 2018-19. The NHS should then be reimbursed for this by EEA countries. It is also assessed that EHIC applications cost the NHSBSA £7.8 million in 2019, giving a combined total expenditure of £80.3 million.


from an approximate expenditure of £80.3 million

0.87% represents the average of claims reimbursed for inappropriate use of the EHIC. 1.64% represents the average percentage of claims paid for the inappropriate use of the EHIC. These are calculated separately as the inappropriate claims are separated by claims reimbursed to other states and claims requested by the state.

Financial fraud vulnerability: £12.06 million.

The effects of COVID-19 could impact on this area’s fraud vulnerability assessment due to restrictions imposed on countries for travel. It would not be possible to determine the cost of EHIC use or fraud during this time and therefore this assessment reflects the potential cost the NHS is vulnerable to losing. COVID-19’s impact is further indicated by the 35% reduction in referrals for this area.

Information reports received for reciprocal healthcare

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


decrease in referrals for this theme compared to last year

2016-17 2017-18 2018-19 2019-20
150 49 37 24