Six-point plan to beat patient fraud in NHS

More work needs to be done to ensure only those who are eligible receive NHS eye tests or optical vouchers, says the Government's counter fraud service

Fraud committed by patients impacts on optical services every bit as much as it does on other parts of the health service that may, nevertheless, receive more publicity. Patients falsely claiming free optical services cost the public purse £13.25m (1998-99) before measures were put in place by the NHS Counter Fraud and Security Management Service (CFSMS).

SUPPORT MATERIAL
In response to this comprehensive range of qualifications for free services, the CFSMS has introduced a number of support materials. In essence, however, the basics of undertaking a PoS check are simple: the patient should provide proof of entitlement to exemption with an approved document and, if this is not forthcoming, the claim to be exempt can be checked.

Because of the detailed nature of the entitlement categories, care taken when checking at the point of service can pay dividends. The Patient Checks and Compliance Unit (PCCU), part of the CFSMS, has had the task of helping practitioners clearly identify the entitlement categories, thus reducing the potential for error or abuse.

The PCCU has recently completed visits to some optical practices with a twofold purpose - to increase practitioners' understanding of what they can do to help reduce patient fraud and to listen to optical practitioners, giving them the opportunity to tell the CFSMS what they want. Information packs were sent to optical practices it was unable to visit. Posters, leaflet and guidance for practitioners and staff have been produced as a result of some of this feedback.

The PCCU has conducted similar exercises to pharmacy and dental practices in England. In September 2004, it began visiting optical practices with the aim of addressing every practice in England. This process is now well under way, with the first round complete and feedback is being collated.

So, with this in mind, how can optical staff and practitioners help prevent valuable NHS resources from being lost to fraud? The answer is simple: by conducting a six-step PoS check whenever a patient claims to be entitled to an NHS sight test or NHS optical vouchers. 

We ask all practitioners to follow a simple process to ensure a patient's entitlement to free NHS care: