I prepay my prescriptions but now face a £150 fine for ‘fraud’

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I have been told to pay a £150 fine by the NHS Business Services Authority (NHSBSA) which suspects me of fraudulently ticking the prepayment certificate (PPC) box on a prescription I collected. As someone with chronic illness, I have been paying for a PPC by monthly direct debit for nine years because it’s cheaper than paying for each prescription separately.

I was told my direct debit payments had been stopped by the NHSBSA when I failed to respond to a renewal letter that I never received. Until now, the PPC has renewed automatically. I was told the practice was started during Covid and the letter was sent to an address I left five years ago and returned to sender. Apparently, the NHSBSA database is separate to the NHS one, so you have to notify the former separately if you move.

Needless to say, the letter detailing my fine reached me at the correct address, and they were able to contact me on the mobile number they had on my file to ensure I pay. I am more than happy to pay for any medication collected since the mandate was cancelled, but is the fine fair, or even legal?
ST, Towcester, Northants

It is certainly not fair. Fines are supposed to punish fraudsters. Miscommunication, not fraud, is the reason for your predicament. In 2019, a parliamentary select committee concluded that the PPC process is a “heavy-handed rush to judgment” on the part of NHSBSA, which checks exemptions for prescriptions and dental treatment on behalf of the NHS, and it accused the Department of Health and Social Care and NHS of “being shockingly complacent” about patients being unfairly penalised.

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You should, of course, have checked when your PPC expired and kept an eye on direct debits, but that’s not as straightforward as it sounds. PPCs are now electronic, rather than being plastic cards, and NHSBSA’s terms and conditions state that certificates will normally be renewed automatically, and that patients who do not wish to renew must cancel their direct debit.

There are no details on when automatic renewals do not apply. Nor do the T&Cs specify that the NHSBSA must be notified separately of a change of address. They simply state they must be informed of “errors” or “changes of circumstance”.

The notification requirement is mentioned on the confirmation of purchase, but it’s the terms and conditions which form the legal basis of a contract.

It is, in my view, reasonable for patients to assume that the NHSBSA and NHS databases will be in sync if they informed their GP of a change of address, and that their PPC will keep renewing. In fact, NHSBSA told me it does use the NHS database when checking patients who claim their age, health or finances make them exempt from prescription charges, before issuing a fine.

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Others, like you, have also been caught out by the misleading terms. The Patients’ Association tells me of a 59-year-old patient who was fined because she was unaware her PPC had not auto-renewed. In her case, the NHSBSA had cancelled the mandate because she would turn 60 and become eligible for free prescriptions nine months after the renewal date. This is also omitted from the terms and conditions.

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The fines are crippling for many patients – five times the amount owed for prescriptions collected without a valid exemption, up to a maximum of £100, which is almost as much as the annual £108.10 charge for a PPC. A 50% surcharge is added if it is not paid within 28 days.

NHSBSA tells me that letters advising a direct debit is about to be renewed have to be sent to patients, and that since yours was returned to sender it decided to cancel the PPC.

This doesn’t explain why yours, apparently, renewed without issue in the five years since you left that address, or why you were told Covid had changed the practice. I asked why, if it was able to access your current address from NHS records to send the fine, and had your phone number, it couldn’t have made another attempt to contact you about the renewal. It replied that it is the patient’s responsibility to check their exemption when collecting prescriptions and, despite evidence that you were not fraudulently claiming free prescriptions, declined to cancel your fine.

According to Gary Rycroft, a consumer lawyer and partner at Joseph A Jones & Co solicitors, the NHSBSA’s insistence on fining patients misled by the terms and conditions is “perverse and inequitable”.

“The words amount to a contractual promise that PPCs will renew automatically unless the patient takes active steps to prohibit that,” he explains. “The failure on the part of the public body to renew when they gave the strong impression they would do so automatically, and the issuing of fines, smack of maladministration.”

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I asked the DHSC if it would ensure patients were treated fairly, but it had nothing to add to the NHSBSA’s response. I suggest you now complain to the Parliamentary and Health Service Ombudsman.

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