Patient Exemption fraud

Patient Exemption fraud covers a range of abuses within NHS services that require payment upfront in return for access, including within Prescriptions, Dental and Optical. In addition, it covers general fraud conducted by patient’s, such as onward sales of prescribed medication.

Patients partaking in the onward sale or supply of prescription medication is highly likely , including via online platforms. Medication may also be sold overseas on lucrative markets.

During the pandemic it is assessed that patients would not have been able to tamper with the electronic prescriptions in comparison to paper ones. The Electronic Prescription Service (EPS) allowed pharmacies to receive prescriptions directly from a prescriber , including after remote consultations.

However, there is a realistic possibility some patients, including repeat offenders, deliberately avoided paying for medication or medical services and remained undetected.

Additionally, it is a realistic possibility that some staff may be confused which benefits qualify. Pharmacy staff are not required to validate or advise on exemption criteria’s, with the responsibility residing with the patient. Therefore, human error continues.

If the consultation to align the upper age for prescription exemptions with the State Pension age is implemented further confusion may be caused. But the expansion of RTEC use and resumption of PECS will improve detection of suspicious exemption claims and potentially deter mis-claimers.

Information reports received for patient fraud