Why is the NHS’s anti-fraud squad pointing the finger at contractors?


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By Beth Kennedy
Editor-in-chief

26 Jun 2019

It’s frankly insulting that the NHS is targeting alleged contractor fraud at a time when insufficient reimbursement  is crippling many pharmacy businesses, says The Pharmacist’s editor-in-chief Beth Kennedy

Earlier this week, The Pharmacist reported that the NHS’s anti-fraud arm, the NHS Counter Fraud Authority (NHSCFA), is cracking down on suspected fraud committed by community pharmacy contractors.

It stands to reason that fraud committed by any contractors, however rare that may be, should be acted upon and condemned in the strongest possible terms, just as it should be for anyone else. But the NHSCFA has gone a step further, making looking into contractor fraud the first – and presumably most important – of its four priorities for the coming year.

In particular, the NHSCFA told The Pharmacist, it will be investigating claims for ‘additional payments’ beyond drug prices.

It said: ‘We are analysing the claims that are made for additional payments beyond the price of the drug supplied, for example out of pocket expenses claimed when a pharmacy has to source a drug it may not regularly dispense, so they may incur charges for courier costs.

‘Most of these claims will be legitimate but we believe that there may be claims that are not.’

As for placing investigating contractor fraud at the top of its list, the NHSCFA said its annual priorities are identified through analysing ‘the best available intelligence assessment of threats’. However, just what this so-called intelligence highlighting contractors in particular has yet to be disclosed. The anti-fraud body is also being tight-lipped about how much money it estimates is being lost through contractor fraud, with a spokesperson clarifying that it is ‘looking to obtain a baseline figure of fraud’ in community pharmacy.

Eh? Don’t get me wrong. Presumably the NHSCFA feels it has good reason to investigate the matter. After all, it stands to reason that every profession will have its share, however small, of bad eggs and it would be unreasonable to assert that no pharmacist has ever committed fraud. But it’s just not quite stacking up for me.

For one, I simply don’t believe that contractor fraud occurs on a large enough scale to warrant such intense scrutiny. The lack of detail from the NHSCFA at present isn’t exactly doing anything to change my mind on that. After all, pharmacists are trusted by the millions of patients who go to them for their medication and to ask their advice every single day. That doesn’t exactly scream ‘fraudster’ at me.

Moreover, the NHS has entrusted pharmacists to tackle fraud themselves, piloting a prescription checking scheme for pharmacists to check patients’ eligibility for prescription exemptions. So, what – are pharmacists really being asked to police patients claiming free prescriptions, only to be accused of committing fraud themselves?

What stings more than anything, though, is the NHSCFA’s suspicion that some contactors are falsely claiming for more reimbursements, when during our War on Shortages campaign so many of you told us that you regularly struggle to claim back enough to cover what you pay for short drugs.

Only time will tell what comes of the NHS’s crack-down, but we at The Pharmacist will be investigating further. We’ll let you know what we find out.


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