The NHS Fraud Reference Guide - Patient

Relates to anyone who is legally living in the UK using the NHS to obtain medical, dental, optical or pharmacy services for treatment, services or medication. primarily concerns an NHS Patient who is a UK resident.

Types of fraud involving this category


Patient charge evasion

This relates to someone who is dishonestly evading payment for chargeable NHS costs. For example, prescriptions, dental treatment and optical services.

Prescription

This relates to someone who is evading payment for prescription charges by deliberately misrepresenting their circumstances.

Dental

This relates to someone who is evading payment for dental treatment by deliberately misrepresenting their circumstances.

Optical

This relates to someone who is evading payment for optical services by deliberately misrepresenting their circumstances.

Misuse of prescriptions

This relates to prescriptions that have been forged, stolen, altered or used by someone other than the named patient.

Stolen

This relates to stolen prescriptions.

Altered/amended

This relates to a genuine prescription that has been falsified in some manner by adding or changing something on it.

Counterfeit

This relates to counterfeit prescriptions produced with intent to deceive.

Used by someone else

This relates to prescriptions used by someone other than the intended patient.

Multi-registration

This relates to someone registering at different practices using their own identity or an alias, to obtain excess NHS medication or services.

Obtained for another

This relates to NHS medication obtained for an NHS patient being provided to someone else, including selling, exchanging or sending abroad.

Lost

This relates to an NHS prescription form being reported as lost by a patient.

Misuse of services/drugs

This relates to someone who is not using NHS services or medication appropriately. They may have lied about themselves, their symptoms or identity to obtain medication. For example, to get temporary GP registration to obtain drugs or be obtaining NHS medication for an improper purpose such as to sell or send abroad.

False symptoms

This relates to someone misrepresenting their medical condition in order to get admitted into NHS care, use ambulance services or obtain medication.

NHS additional funding

This relates to additional funding paid by the NHS for help and care where there are concerns about the legitimacy of the claim or the way that the money is spent.

Payment in lieu

This relates to someone who is in receipt of direct payments for healthcare, usually paid via an NHS personal health budget, that they are not entitled to.

Funded healthcare

This relates to dishonestly obtained funding for a package of care provided by the NHS to meet ongoing health care needs outside a hospital setting. For example, continuing healthcare funding.

Travel costs

This relates to someone who is claiming NHS funding for travel to hospital which they are not entitled to.

Compensation

This relates to someone who is claiming NHS funding for travel to hospital which they are not entitled to.

Registration details

This relates to someone who has used false information about themselves in order to register for NHS services.

Registered identity false

This relates to someone who has used the identity of another person for the purposes of registering as an NHS patient to access NHS services.

Registration address false

This relates to someone who has registered for NHS services using an address where they are not a resident.

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