Employment and Support Allowance - Non-intentional prescription fraud

Twp1989

Hello,

I'm new here and am hoping that I can find some help and advice with my frankly embarassing and worrying situation.

Basically, I am unemployed and I have severe depression and anxiety disorder and I have been claiming ESA since February 2013. Originally, I was led to believe that if I was on ESA that I could claim free NHS prescriptions and so I went to my local pharmacy and enquired and they said yes as long as I have proof of my ESA claim. I took them my letter, they took one look at it without so much as reading it and said it was fine. They didn't even query which form of ESA I was claiming.

I continued to pick up my medication and tick the ESA box on the prescriptions all this time assuming everything was in order until today. I happened to glance at the small print and discovered that, actually, I can only get free medicine if I am claiming Income-based ESA. I freaked out completely and was really worried and lo and behold, after reading back through my paperwork, I am on contribution-based ESA and this does NOT entitle me to free medication!! I had absolutely no idea about this at all as I was always led to believe that I was getting Income-based ESA.

So now I am pretty damn worried because I have now unintentionally committed fraud by claiming free prescriptions when I wasn't entitled in the first place but because nobody queried it, I just assumed it was all good! I'm really scared now and this has caused my anxiety to flair up really badly and I am worried sick that I will be thrown in jail.

I NEVER intended to commit fraud at all in any way, shape or form and I certainly did not intentionally lie just so I could get free medicine, I am not that kind of person at all. I didn't knowingly commit fraud to gain my own means - like I said, I just assumed and made a mistake and nobody seemed to query anything.

What I really need to know now is what can I do to remedy this situation? Have I committed fraud in any way and what will the outcome of this be? Who do I need to contact to explain all this and say I made a mistake and it was not my intention to do this at all? I would be gladly willing to pay back all the money I owe from this, even if that means a fine (as I know I could be fined £100 if I was found to be committing fraud for prescriptions).

Any help would be hugely appreciated.

Adereterial

Do you have any other household income (including a partner's income) or savings over £16,000? Or have you had, at any point in your claim?

If not, you're likely to have an underlying entitlement to ESA(IR) anyway.

I don't think there's anything you CAN do to rectify, easily anyway, if you have not been entitled, but it's unlikely you'll face prosecution. I'd be surprised if it was ever picked up on, if I'm honest.

Torry_Quine

First of all relax, you aren't going to jail. You made a genuine mistake. If this is your only income then you could well be eligible for free prescriptions anyway.

http://www.nhs.uk/NHSEngland/Healthcosts/Pages/nhs-low-income-scheme.aspx

Twp1989

Hi Adereterial,

No I don't have any other income or savings of more than £16,000 and I never have had any during my entire claim. My paperwork does state what I would get on IS-related ESA but below that it says "However, because you are entitled to Contribution-based ESA...".

I heard that the NHS was picking up the pace on the spot checks on claimants for free prescriptions.

webtalk

The first thing to do is take a deep beath and try not to panic.

Go to your pharmacy in the morning. Speak to the pharmacist or manager -no one else. Thake down their name and log time of visit.

Explain that although you were advised you did not have to pay you now realise you do.

Say you want to fix it asap and pay back the money.

Ask for the name, address and telephone number of the relevant nhs/prescription department you needto contact.

See if they have any advice. Don't take it if they say 'I think' because it means they are guessing.

Call the relevant organisation on Monday - two calls.

First one anonymously to get advice on how to fix the error in the simplist and quickest way possible.

Second is to declare the error and discuss rectifying it asap.

Don't talk about fraud. Explain the mistake as calmly and simply as possible. No unnecessary detail. Just facts. And emphasis3 desire to correct error and pay back money.

Good luck.

Twp1989

Thanks so much for all your help with this guys. I will definitely get in touch with the pharmacy ASAP and go from there.

joff81

If you have no other income and no savings then its likely you are in receipt of both IR and CB ESA. The IR is always used to top CB and as you are likely to be receiving both you are not committing any fraud.

All you need to do is ring DWP and for a breakdown of the ESA you receive then go from there.

Dovah_diva

My advice is to do nothing. It is highly unlikely anyone will have even noticed. Start paying for your prescriptions going forward, but in respect of the past prescriptions, I'd do nothing.

zzzLazyDaisy

Dovah_diva wrote: »

My advice is to do nothing. It is highly unlikely anyone will have even noticed. Start paying for your prescriptions going forward, but in respect of the past prescriptions, I'd do nothing.

I agree that it is very unlikely anything will happen, as they don't have the manpower to check all prescriptions.

But going forward, paying for prescriptions is not good advice. You are almost certainly entitled to free prescriptions under the law income scheme. You can order an application form online, or your GP's surgery may be able to give you one. See here for more details

http://www.nhs.uk/NHSEngland/Healthcosts/Pages/nhs-low-income-scheme.aspx

epitome

joff81 wrote: »

If you have no other income and no savings then its likely you are in receipt of both IR and CB ESA. The IR is always used to top CB and as you are likely to be receiving both you are not committing any fraud.

All you need to do is ring DWP and for a breakdown of the ESA you receive then go from there.

This is not correct, the OP has a letter saying how much ESA IR he would have got but it goes on to say "however since you are eligible for ESA C....." This implies that his ESA C pays the same or more than his ESA IR, in which case he has no ESA IR at all. The letters clearly say -always- that you get C or you get IR the letters never say "both".

OP answer these questions

Do you have a partner?
Do you have more than £6000 in savings?
What does the letter say your award £££ for ESA IR would be & ESA C is?

When you apply for a HC1 help with health costs you can ask that it is backdated.

If I were you I would only speak to the pharmacy to make them aware of their lack of knowledge, they should have understood the letter has to say ESA Income Related.

I would then apply for a backdated HC1 form and this process will likely flag up to NHS the errors that have been occuring and then NHS can ask you about it if they want to.


What were you on or doing before ESA started? How long have you been ticking the box for free prescriptions? How many prescriptions and dental treatments optician treatments have you had free?

schrodie

As some have said don't worry about it. It was a genuine mistake and given the millions of scrips that are filled every day I very very much doubt they'll come knocking on your door.

Just forget all about it but if you're entitled to free prescriptions get the forms filled out.