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Fraudulent registration by patients

June 2006

This guidance has been produced with the assistance of the NHS Counter Fraud and Security Management Service (CFSMS). It is relevant to GPs in England.

• Introduction
• What is the NHS Counter Fraud and Security Management Service (CFSMS)?
• What practices should do about suspected fraudulent registration
• What to look out for

Introduction
Fraudulent registration by patients occurs when patients register at multiple practices, usually providing false personal details with a view to obtaining prescriptions from each. The problem, according to the CFSMS, is widespread with in excess of 20 individuals having already been successfully prosecuted for the use of an alias to obtain controlled drugs. In one particular case an individual was found to have over 50 different aliases, although generally a figure between two and 10 is more usual.

What to look out for
Though not prescriptive, the points below give an idea of occasions when extra care should be taken to ensure the identity of an individual and the veracity of his or her claims:

• temporary residents unable to provide identity or unsure of their current GP’s details
• patients who claim to be ‘just in the area’ and have a specific complaint that they have forgotten medicine for
• together with the above, the use of ‘easy-to-remember’ dates of birth (e.g. 1/1, 25/12, 31/12). These enable someone who is using different names to ensure that they always remember the date of birth given (such dates may also be used on the rare occasions where patients are not aware of their date of birth).

The above should not be taken in isolation as being evidence of an attempt to obtain drugs by deception but are more an indication of how offences are perpetrated.

What practices should do about suspected fraudulent registration
The IT Directed Enhanced Service (DES) may help to tackle problems with fraudulent patients by encouraging practices to maintain accurate patient addresses using opportunistic regular validation (eg at the point of referral).

All practice staff should be informed of reporting procedures in case they become aware of fraud in the practice.

CFSMS is currently producing a GP Practice Counter Fraud Policy which will deal with reporting procedures, what management and staff should do in the event of suspected fraud, and the attainment of Quality and Outcomes Framework (QOF) management point 8 through implementation of anti-fraud measures.

In the meantime, local counter fraud specialists can be contacted via the primary care trust (PCT) for any queries or assistance. In addition, anyone with concerns about patients registering with false identities within the NHS can call the confidential NHS Fraud and Corruption Reporting Line on 0800 028 40 60 or email nhsfraud@cfsms.nhs.uk. Reports can be made anonymously. Alternatively, concerns can be put in writing to:

Practitioner Services Unit
Charter House
Parkway
Welwyn Garden City
Herts
AL8 6JL

All reported cases are investigated.

What is the NHS Counter Fraud & Security Management Service (CFSMS)?
The NHS Counter Fraud & Security Management Service was set up in 1999 to tackle losses resulting from fraud & corruption within the NHS. Investigations are undertaken into fraud or corruption that have been committed by patients, NHS employees or contractors. Appropriate criminal, disciplinary and/or civil sanctions are taken against those proven to be committing fraud or corruption.

Further information about CFSMS can be found at the CFSMS website