The NHSCFA estimates that the NHS is vulnerable to £91 million worth of General Practice fraud each year.
General Practice fraud relates to the manipulation of income streams or activities that violate contractual terms perpetrated by either practitioners or staff members. Up to 60% of GP practice income is derived from payments which allocate resources according to relative workload associated with each practice.
The main fraud types in this category are:
- False claims by general practices for allowances, reimbursements, expenses or grants which are not related to patient care.
- Unlawful prescribing by general practices. For example, prescribing to patients who do not exist, are deceased or self prescribing.
- Deliberate misrepresentation of patient list size and/or demographics by health care service providers in order to attract higher funding. For example, older patients who attract higher funding not being removed from the practice list when they are deceased or fictitious patients being created to attach higher funding.
- Where a general practitioner’s decision making in respect of commissioning is suspected to be influenced or impaired by a personal interest, role or relationship. For example, where they misuse their position to further their own interests or those close to them, in order to obtain a financial gain or another type of benefit or advantage.
For a full list of fraud types in this category, please check General Practitioners in the fraud definitions.
To assist you on how to spot the signs of General Practice fraud and how to put measures in place to stop this type of fraud, please see below
- Are patient records being updated accordingly if they are no longer with the practice or are deceased?
- Is there enough separation of duties and adequate management of prescription forms throughout the practice?
- Are false claims being made in respect of patient demographics, allowances or, reimbursements.
This animation shows an example of claiming for NHS care that was never delivered through the creation of fake patients. It highlights the importance of reporting fraud and the consequences for those who commit it.
Case Study 1
A practice manager transferred a total of £596,000 over a three-year period to bank accounts she set up to pose as suppliers to the surgery.
The practice manager manipulated accounts at the Medical Practice to cover her tracks, transferring funds from one year’s records to the previous years to hide shortfalls created by the fraud. The fraud and missing funds were only discovered after she quit her role at the practice.
The practice manager was jailed for two years and the monies lost to this fraud were recovered in full.
Case Study 2
A doctor forged over 400 prescriptions in the names of three of his patients and obtained medicines to treat himself for depression using the name of his patients. In total, the doctor forged 243 prescriptions in the name of one of his male patients, 173 in the name of another, and 24 using a third patients’ identity.
The total value lost to the NHS was £10,047 and the patient details he used were all entitled to free prescriptions and did not have to pay.
The doctor was given a four months jail sentence suspended for 12 months and ordered to pay £10,047 compensation to the NHS within a year, after he pleaded guilty to three charges of fraud.
How to report fraud
Report any suspicions of fraud or attempted fraud to the NHS Counter Fraud Authority online at https://cfa.nhs.uk/reportfraud or through the NHS Fraud and Corruption Reporting Line 0800 028 4060 (powered by Crimestoppers). All reports are treated in confidence and you have the option to report anonymously. You can also report to your nominated Local Counter Fraud Specialist if you are an NHS employee or contractor.