Reciprocal healthcare

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

Reciprocal healthcare (RH) encompasses fraudulent use of European Health Insurance Cards (EHICs), Global Health Insurance Cards (GHICs) and various other reciprocal healthcare arrangements. Also, false representation during the application stage for a card or certificate which enables the holder to benefit from a RH agreement.

£1.94m

vulnerable from an expenditure of £126.4m

There is a realistic probability some individuals visiting the EU without travel insurance would have required treatment for COVID-19, resulting in an application for a retrospective EHIC/GHIC instead of a Provisional Replacement Certificate (PRC).

It is also a realistic possibility that patients may falsely claim to be insured by the UK through presentation of a British passport when seeking care in Norway . The new GHIC and most legacy EHICs are no longer valid in the European Economic Area (EEA), but a British passport can be used in Norway to access entitlements . Thus, allowing individuals who are not ordinarily a resident in the UK to access healthcare without charge whilst in Norway.

It is highly likely that the reliance on the EHIC/GHIC card holder to notify the NHSBSA of a change in circumstances enables fraudulent use. It is also highly likely that these individuals continue to use the cards when they move abroad, including for planned care. There is also the potential for a deceased individual’s card to be used by another.

It is possible for EHIC/GHIC holders to share their genuine card with an individual of a similar age who is not entitled to care without charge. It is also a possibility that an individual who is insured by the UK may share their personal information with an associate, so they are able to request a PRC via a telephone call . Most EHIC/GHICs and PRCs are lacking in security measures to confirm a patient’s identity, including no facial image.

The NHSCFA is almost certain that some GHIC/EHIC applicants submit false addresses , documentation , or another’s personal information to falsify ordinary residence in the UK. This is because an applicant’s address is used to confirm their eligibility / residency.

A new reciprocal healthcare agreement between the EU and UK was introduced on 31/12/2020, it includes the GHIC, a new UK EHIC and the legacy EHIC. As the GHIC will gradually replace the EHIC for most individuals in the UK, the NHSCFA is likely to see an increase in GHIC specific fraud reports alongside a reduction in EHIC. Also, the return of travel to pre-pandemic levels may result in increased fraudulent activity. The NHSCFA will continue to monitor reporting for both trends.

Information reports received for reciprocal healthcare

The increase in reporting in 2020-21 could potentially be attributed to the media attention around the UKs exit from the EU and a GHICs introduction. However, this year’s decrease is more fitting for the downward trajectory in travel and the reduced financial vulnerability.

47.62%

decrease in reporting compared to last year

The change in the number of fraud reports (allegations) received in relation to reciprocal healthcare from 2017-18 to 2021-22:

2017 to 2018 2018 to 2019 2019 to 2020 2020 to 2021 2021 to 2022
32 15 14 21 11