The NHSCFA estimates that the NHS is vulnerable to £259.5 million worth of Help with Health Costs fraud (patient fraud) each year.
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.
The main fraud types in this category are:
- Prescription charge evasion: £179.3 million
- Dental charge evasion: £41 million
- Optical voucher abuse: £39.2 million
Any persons dishonestly claiming that they are exempt from charges when they are not are engaging in unlawful activity and denying the NHS of vital revenue.
To assist you in understanding your entitlements, please see below.
- Check that you are entitled to claim an exemption from an NHS charge before ticking any exemption box.
- You will be required to sign a declaration on the prescription form confirming you understand your entitlement.
- If you are in receipt of an exemption and your financial circumstances change, it is your responsibility to check whether you remain entitled to continue to claim for free treatment or services.
- Not all benefits entitle you to free prescriptions, ask your pharmacy team for more information.
- To find out if you are entitled to help with health cost: Click here
- For information on when you need to pay towards NHS care: Click here
- For information about free prescriptions: Click here
- Information for pharmacies - Help your patients avoid penalty charges: Click here
- Help with understanding your eligibility for free prescriptions: Click here
A patient was convicted of fraud having dishonestly avoided paying prescription charges for nine prescriptions by indicating on the rear of the prescription forms that the patient held a valid NHS Tax Credit Exemption Certificate.
Checks were carried out which showed the patient did not hold this exemption.
The patient admitted deliberating ticking the box knowing that they did not have the exemption for the purpose of dishonestly avoiding paying for the prescriptions.
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.