The NHS Fraud Reference Guide - Financial reporting

This relates to financial accounting, incentives or penalties. This would include Payment by Results matters.

Types of fraud involving this category


Payment by Results (PbR)

This relates to claims for payment made under the PbR scheme, which is the payment system in England under which commissioners pay healthcare providers for each patient seen or treated.

Up-coding/over-coding

This relates to the deliberate falsification of treatment codes with the intention of attracting a higher value than should be paid.

Billing for service not rendered

This relates to the NHS being billed for medical treatment or for equipment that has never been provided.

Double billing

This relates to the NHS being billed for the treatment of patients who are in fact private patients and have paid as such.

Perverse incentives

This relates to the abuse of a payment scheme, where the objectives of the NHS or the interests of the patient are being exploited, in favour of the incentive. This includes where referrals or treatment decisions are adversely influenced by factors other than patient choice or best clinical interests.

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