Errors, suspected misuse, audit and speaking up

Errors can occur in a busy optical practice. Report honest mistakes promptly so they can be corrected. More serious is concealing an error, altering records without an audit trail, blaming the patient, submitting a claim anyway, or accepting pressure that makes unsafe practices routine.

Suspected misuse includes duplicate claims, incorrect voucher values, claims for services not provided, claims for appliances not supplied, claiming NHS payment in addition to private payment, backdating forms, fabricated evidence, false patient declarations, or pressure to record untrue information.

What to do when something is wrong

• Make the immediate situation safe: stop the claim or transaction if it has not been submitted.
• Preserve facts: keep relevant forms, system notes, dates, names, messages and audit logs.
• Tell the right person: report to the manager, claims lead, contractor, supervisor or use the speaking-up route.
• Correct through the proper route: use the official amendment, void, repayment, query or refund process.
• Do not retaliate: staff should not be punished for raising genuine concerns.
• Learn from patterns: repeated errors may indicate training, workload, system or cultural problems.

Speaking up

If staff are asked to submit a claim that appears false, conceal an error, use another person's login, sign for a patient without consent, backdate a form or ignore audit findings, they should speak up. Start with local routes if it is safe to do so. If the concern is serious and local escalation fails, use external routes.

Manager audit, counter-fraud and external routes

Deadlines do not make inaccurate claims acceptable. Correct errors early, keep a clear record of facts and speak up if honesty is at risk.