Inspection and Regulation

15.05.19

NHS lost £212m from prescription fraud last year whilst 1.7m people wrongly fined, NAO finds

Around 1.7 million fines have been wrongly handed out to patients and then overturned in the last five years, whilst the NHS also lost £212m last year due to wrongly claimed exemptions, the National Audit Office (NAO) has found.

The new report revealed that thousands of “innocent” NHS patients were slapped with incorrect healthcare fines over dental treatment and prescription charges since 2014, worth a total of £188m.

The government’s spending watchdog investigated the NHS’s use of penalty charge notices (PCNs) which can be issued to those who claim a free dental prescription or dental treatment either fraudulently or in error.

Elderly, under 16s, disabled and some people who receive certain benefits are normally exempt, but the NAO found that nearly a third of PCNs issued since 2014 have been subsequently withdrawn after they were challenged.

Around 400,000 dental patients a year, including those on low incomes, with disabilities and the elderly, have received £100 fines for simply ticking the wrong box.

The British Dental Association (BDA) welcomed calls for clarity on NHS penalty charges and said the report identifies multiple sources of mistakes and confusion, as well as raising “deep concerns” that an increasingly aggressive approach to penalty charges has fuelled a drop in attendance.

The NAO investigation also revealed that the NHS estimates it lost around £212m in 2017-18 from people incorrectly claiming exemption from paying prescription and dental charges.

Since April 2014, The NHS Business Services Authority (NHSBSA) has attempted to recover NHS funds from incorrect claims by managing the distribution of 5.6m PCNs worth a total of £676m, of which £133m has been collected, £297m resolved without a penalty being paid and £246m still outstanding.

The NAO said it recognised that free prescriptions and dental treatment are a significant cost and that it is important to reclaim funds from people who are not exempt and to deter fraud, and there has been a significant increase in exemption checks and PCNs since 2014.

But it criticised the “complicated and difficult to understand” system and rules, and said the NHS “also needs to have due regard to people who simply fall foul of the confusing eligibility rules.”

Chair of the BDA’s England Community Dental Services Committee, Charlotte Waite, said: “There can be no excusing the fact innocent people, fully entitled to claim free care, have been slapped with over £180m in fines.

"Patients deserve real clarity when making a claim. Sadly, all the government has done is spend a fortune on campaigns simply discouraging them from seeking the help they need and are entitled to.”

She added that the England system was “built on a presumption of guilt” that leaves vulnerable patients being chased by debt collection agencies, whilst other UK nations have taken a different approach.

Image credit - MJ_Prototype

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