NHSCFA Thematic Fraud Areas

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

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    Procurement and commissioning of services fraud

    Procurement and commissioning of services 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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    Community pharmaceutical contractor fraud

    Community 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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    Patient Exemption Fraud

    Fraud within the main NHS services that require payment upfront in return for access; like prescriptions, dentistry and ophthalmology. It also encompasses the onward sale or supply of prescribed medication.

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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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    Data manipulation

    Fraud through falsifying data to meet targets, increase revenue or hide undesirable outcomes.

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    General Practice (GP) contractor fraud

    General Practice (GP) contractor 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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    Reciprocal healthcare fraud

    Reciprocal healthcare encompasses fraudulent use of European Health Insurance Card (EHIC), Global Health Insurance Cards (GHIC), Provisional Replacement Certificates (PRCs) and various other reciprocal healthcare arrangements. It also includes false representation during the application stage which can enable the card / certificate holder to benefit from a reciprocal healthcare agreement.

  • Image of NHS optician performing an eye examination.

    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.

  • Image of NHS Dentist looking at an xray of teeth.

    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 from overseas visitors

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

  • Image of retired NHS employees looking at penision documents.

    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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    NHS Bursary

    NHS Bursary 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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