£230.2m is vulnerable from an expenditure of £11.8 billion. Please see our latest strategic intelligence assessment for more details.
The three main fraud types in this category are:
- Patient charge evasion – relates to an individual who is not exempt from NHS charges for treatment, services or medication purporting to have an exemption to avoid paying costs. Prescription charge evasion accounts for the majority of this. Real Time Exemption Checking (RTEC) | NHSBSA (available on the NHS Business Services Authority) continues to have a positive effect on charge evasion.
- Identity theft to register for NHS services or medication – Individuals using false, stolen or family identities to register for NHS services or access medication. Most commonly linked to those unlawfully in the UK to avoid detection and enabled by the misconception that the NHS may pass their details to Immigration Enforcement.
- The onward sale or supply of prescription medication for personal gain – Individuals selling unwanted or unused medications, as well as intentionally obtaining controlled medication via deception, specifically to sell for profit, particularly in lucrative markets abroad.
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.
Think Prevention
Patient charge evasion
- 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.
- Not all forms of Universal Credit entitle the recipient to free prescriptions as well, keep the further info also.
Identity theft to register for NHS services or medication
- The NHS do not share patient information with immigration authorities and those without legal status can still register with a GP free of charge.
Onward sale or supply of prescription medication for personal gain
- Always return unwanted or unused medication and never sell it.
- Report individuals via our website who are selling their prescription items.
Further information
Case study
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/report-fraud 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.