Optical contractors

Optical contractor fraud involves submitting claims to the NHS for optical treatments, services or enhancements which were not delivered or clinically required.

In response to COVID-19, practice staff were advised by an optical Standard Operating Procedure (SOP) to remotely triage or risk assess patients unless a face-to-face appointment was essential. However, as appointments were dealt with via telephone there is a realistic possibility that claims were submitted for services which were not actually provided.

It is a realistic possibility that some opticians falsely claimed to have dispensed items or conducted activity to receive a reimbursement/fee as routine services resumed. This could be as a direct result of a temporary suspension in the requirement for patient signatures on electronic General Ophthalmic Services (GOS) forms during COVID-19 or having to meet 40% GOS contributions to maintain income support.

Similarly, some staff may even go as far as to submit false claims for providing treatment to deceased former care home residents. Others may charge both the NHS and the patient for the same private appointment or prescription. However, each month a sample of selected GOS contractors partake in a post-payment verification (PPV) administered by NHSBSA to review the accuracy of claims.

It is likely that as optical contractors return to routine care there will be testing or dispensing irregularities, including dispensing more glasses than required or recalling patients for check-ups sooner than clinically necessary. High reporting has previously been experienced in this area and as opticians are already reporting an increase in sight impairments/loss compared with before the pandemic it may increase again.

Information reports received for optical contractors

The change in the number of fraud reports (allegations) received in relation to optical Contractors from 2017-18 to 2021-22: Spend decrease and reporting increase.