News Release: NHSCFA targets £119m optical fraud problem

NHSCFA, which leads nationally on fighting NHS fraud, is attending this major optical industry event to raise awareness about fraud in the sector and engage the help of the optical community.

We have estimated that the sector costs the NHS an eye-watering £119 million every year in optical contractor fraud (£48m) and optical patient fraud (£71m) - out of an estimated total of £1.29 billion lost by the NHS to fraud annually.

The primary areas of optical fraud involve:

1. Patients claiming exemption from payment when they are not entitled
2. Unjustified early sight test recalls by contractors
3. Contractor claims where patients did not receive the claimed-for service
4. Contractor claims for a service the patient paid for
5. Patient did not receive the service the contractor claimed for

Sue Frith, Interim CEO of NHSCFA, says: "There is a clear gap between the probable scale of the problem and the seeming scarcity of optical fraud prosecutions and referrals in recent years, which must be closed. Attending 100% Optical is an important opportunity for our organisation to amplify this message."

Richard Hampton, Head of Intelligence and Fraud Prevention at NHSCFA, will address the conference at 1.45pm on Monday 29 January: "I will be setting the scene and putting optical fraud in the wider context of NHS fraud, but also focusing on how this audience can play its vital part in rooting out optical contractor fraud specifically".

NHSCFA staff will be at stand B67 throughout the weekend and on Monday.

Paul Gilderdale, Senior Fraud Prevention Officer, works in liaison with NHS England and others to close down and prevent the opportunities for individuals to commit optical fraud: "NHSCFA works to propose system-wide improvements to optical claims and payment systems".

NHSCFA's intelligence unit has analysed how the claims and payment system for General Ophthalmic Services operates‎ and estimated the level of fraud being committed by both contractors and patients. Its Fraud Prevention Unit has identified a number of areas where improvements to systems can be made and is committed to working with NHS England ‎to improve claim submission and payment verification processes to reduce fraud in the future.

If you suspect that anyone is committing fraud or another economic crime against the NHS, tell NHSCFA about it - you can call our 24-hour, confidential reporting line 0800 028 40 60 or use our online reporting tool

"NHS fraud. Spot it, report it, together we stop it"

For more information contact James Robertson or Rianne Endeley-Brown at the NHSCFA press office on 020 7895 4524/4523.

Download this press release.

Notes to Editors

1. For more details visit the website www.cfa.nhs.uk
2. NHS Counter Fraud Authority is a Special Health Authority established under the NHS Act 2006 as amended.
3. When NHSCFA uses the term 'fraud', we refer to a range of economic crimes, such as fraud, bribery, corruption or any other illegal acts committed by an individual or group of individuals to obtain a financial or professional gain.
4. NHSCFA will also support the work of the NHS Counter Fraud Service (Wales)
5. NHSCFA will work closely with NHS Local Counter Fraud Specialists across the NHS in England to ensure that healthcare crime is tackled and a culture of fraud prevention and deterrence is in place.
6. There are some 300 professionally trained and accredited Local Counter Fraud Specialists in place within health bodies across England and Wales.