NHS lost £212MILLION last year through prescription fraud
NHS lost £212MILLION last year because people wrongly claimed free prescriptions and dental work – but experts blame ‘complicated’ system and say only one in five fines are paid
- The National Audit Office released a report detailing how much money is lost
- It found prescription fraud has risen 10-fold from £12m to £126 in four years
- Although the penalty charge process cuts down on fraud it cost £11m last year
- And almost a third of fines are sent to someone who has a genuine exemption
The NHS lost around £212million last year to people who wrongly claimed their prescriptions or dental work for free.
Fines sent to patients who should have paid for their medicines totalled £126million in 2018-19, a 10-fold increase from £12million four years earlier.
The Government’s National Audit Office, which published the figures, said the NHS is losing money in part because its prescribing system is too complicated.
And the Royal Pharmaceutical Society added it would be simpler if prescriptions were free for everyone.
Almost a third of patient fines (30 per cent) were found to have been sent in error but the NHS is still owed £246million by people who haven’t paid up since 2014.
There has been a ‘significant’ increase in the number of penalty charges sent to people who are thought to have claimed prescriptions for free without a genuine reason (stock image)
The NAO report said there has been a ‘significant’ increase in the number of checks the NHS has to run on people claiming they are entitled to free medicine.
On top of the £126m lost because of prescription charges not paid, £72m was lost to dental treatments – up from £38m.
Although the system claims to have reduced prescription fraud by £49m per year between 2012 and 2017, sending out the fines last year cost £11.2m.
Between September 2014 and March 2019, more than 114,000 people were sent five or more penalty charges – but only one was ever taken to court.
As well as people defrauding the health service to get medicine for free, there are widespread concerns a ‘confusing’ system is leading people to break the rules by accident.
The NAO said in a release: ‘Rules around entitlement are overly complicated leading to genuine mistakes and confusion for many people’.
More than one in three people (36 per cent) sent a penalty charge notice since 2014 have not paid it even though they should have.
Only one in five fines – adding up to £133m out of a total £676m – have actually been paid during that time.
Others should never have been sent in the first place or the patient has been let off or just ignored the fine.
‘It would be much simpler to have free prescriptions for everyone, as is the case in Scotland, Wales and Northern Ireland,’ said Sandra Gidley, chair of the Royal Pharmaceutical Society in England.
WHO CAN GET FREE PRESCRIPTIONS IN ENGLAND?
The NHS offers free prescriptions only to certain groups of people in England – the standard charge for a single dispensation is £9.
In Scotland, Wales and Northern Ireland medicines are free for everybody.
In England the following people can get prescriptions for free if they have an exemption certificate:
- 16 to 18-year-olds in full-time education
- Pregnant women or mothers with babies up to a year old
- Hospital inpatients
- People on various benefits, including income support, Jobseeker’s Allowance, Universal Credit or Child Tax Credits
- Those with a constant physical disability which means they cannot go out alone
- Cancer patients
- People with diabetes
- People with other long-term conditions including myoxedema, myasthenia gravis and Addison’s disease
To find out more about eligibility or to apply for an exemption certificate visit the NHS Business Services Authority website
‘Then no-one would have to worry about filling out a form of declaration. They would always have the medicines required, without having to make payment decisions.
‘It would also enable the [money spent on] issuing and monitoring penalty charge notices to be spent on patient care.’
As well as fraud by people trying to avoid paying for their medication, many of the fines are issued to patients who haven’t used the exemption process correctly.
This, according to Labour MP Meg Hillier, is a sign the NHS procedure for qualifying for accessing free prescriptions doesn’t working well.
‘It is right that the NHS tackles prescription and dental fraud,’ she said. ‘But the NAO’s report makes for concerning reading; the rules around entitlement are complicated, leading to confusion and genuine mistakes.
‘Almost of a third of prescription and dental penalty charges issued to patients were later revoked, because they had a valid exemption.
‘This is not a system that is working as it should.
‘The NHS must take urgent steps if it is to avoid causing unnecessary distress to patients, tripped up by an overly complex system, who end up facing large penalty charges.’
Ms Hillier’s sentiments were echoed by the Prescription Charges Coalition.
‘The fact that 30 per cent of penalty charge notices are wrongfully given because of the confusing system confirms that it is excessively complex, out of date and a waste of money,’ said the PCC’s chairman, Lloyd Tingley.
‘People with all long term health conditions should be made exempt from paying the charge, which would reduce the figures of deviant prescription charge notices and make a more effective and fair system.
‘Research shows that scrapping charges for just two conditions, Parkinson’s and inflammatory bowel disease, could save the NHS over £20m every year by reducing unnecessary GP visits and hospital admissions caused by people not collecting all the medication they’ve been prescribed, because they simply can’t afford it.’
There are around 1.1billion prescriptions filled out by the NHS every year, and around 89 per cent of them are claimed for free.
The NAO’s audit also included dental work, of which around 47 per cent is done for free for people who have – or claim to have – medical exemptions.
People entitled to free prescriptions include over-60s, under-16s, people in full-time education, people on income support or Jobseeker’s Allowance, those with certain permanent disabilities, and cancer patients.
The fine for wrongly claiming a prescription for free can be up to £100 plus the cost of the prescription – usually £9 – and is sent by the NHS Business Services Authority.
As well as those claiming free prescriptions because of a misunderstanding, millions of pounds may be being lost because of deliberate fraud.
‘Something is clearly going wrong here, with so many cheating the system,’ said John O’Connell, chief executive of the TaxPayers’ Alliance.
‘The NHS has limited resources and money taken away through fraud is money that could be going towards medical treatment and emergency care.
‘Either the rules need to be made clearer or enforced more harshly.’
A spokesperson for NHS Business Services Authority (NHSBSA) said: ‘The NHS loses millions each year to fraud and error and the NHSBSA has recovered in excess of £86m since 2014 when we began administering the service.
‘We continue to work with NHS England and the Department of Health and Social Care.
‘Together we agree the most appropriate action to take where patients repeatedly claim free prescriptions; or exemption from other NHS charges where they do not hold entitlement to the exemption claimed and refuse to change their behaviour.
‘Trained staff investigate repeat offenders and where appropriate a file is submitted to the Crown Prosecution Service (CPS) who will make the decision on whether the matter is progressed to court or not.’
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