NHSCFA Thematic Fraud Areas

This section provides a detailed look at 13 key areas of fraud, including examples and prevention advice.

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    Procurement & commissioning fraud

    Procurement and commissioning fraud relates to allegations of collusion, bribery and corruption within the pre-tender stages of the procurement and commissioning process. It also relates to false, intentionally inflated or duplicate invoices within the post tender stages.

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    Pharmaceutical contractor fraud

    Pharmaceutical contractor fraud relates to false claims for either the dispensing of items or for one of the enhanced services offered at the pharmacy.

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    Help with Health Costs

    Patient fraud relates to an individual who is not entitled to free NHS treatment, services or medication but who purports to be exempt from paying for the costs of prescription charges, dental treatment and optical services.

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    NHS staff fraud

    NHS staff fraud relates to a member of staff who fraudulently inflates or falsifies their income, expenses or working hours for financial gain.

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    National tariff & performance data manipulation

    Fraud in relation to national tariff and performance data manipulation relates to the intentional falsification of data and the Payment by Result (PbR) system.

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    General practice fraud

    General Practice fraud relates to the manipulation of income streams or activities that violate contractual terms perpetrated by either practitioners or staff members.

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    EHIC fraud

    European Health Insurance Card fraud occurs when overseas visitors claim for treatments under EHIC when they are not entitled to do so.

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    Optical contractor fraud

    Optical Contractor fraud occurs when optical contractors (opticians) submit fraudulent claims to the NHS for a range of services provided to patients.

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    Dental contractor fraud

    Dental Contractor fraud occurs when dental contractors (dentist) submit fraudulent claims to the NHS for a range of services provided to patients.

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    Fraudulent access to NHS care

    Fraudulent access to NHS care relates to foreign nationals who obtain free healthcare to which they are not entitled.

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    NHS pension fraud

    NHS Pension fraud relates to an individual who has either falsified their circumstances or failed to notify of a significant change in their circumstances to the pension administration.

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    Fraud against NHS Resolution

    Fraud against NHS Resolution relates to fraudulent accidents/ insurance claims under the Liabilities to Third Parties Scheme (LTPS) or through clinical negligence.

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    NHS student bursary fraud

    NHS Student Bursary Scheme fraud relates to false applications or the use of false documents to support a bursary application, other NHS funded training or financial support stream.

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