The NHS will crack down on suspected expenses fraud committed by community pharmacy contractors, it announced last week (10 June).
The NHS Counter Fraud Authority’s (NHSCFA) business plan for 2019-20 sets out tackling fraud within community pharmacy as the first of its four strategic priorities for the coming year.
An NHSCFA spokesperson told The Pharmacist this will focus on claims for ‘additional payments’ beyond drug prices.
They 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.’
NHSCFA said its annual priorities are identified through analysis of ‘the best available intelligence assessment of threats’.
When asked how much it is estimated is being lost through contractor fraud, a spokesperson said the NHS body is ‘looking to obtain a baseline figure of fraud’ in community pharmacy.
Working with the NHS Business Services Authority (NHSBSA), the NHSCFA will identify ‘key areas of loss to fraud and potential fraud’ by community pharmacy contractors, its business plan said.
It added: ‘This will provide opportunities to identify and develop fraud referrals or intelligence packages on individuals and/or companies for investigation/disruption activity.’
NHSCFA will also ‘identify appropriate enforcement opportunities’ and increase its referrals to NHS England and its own Tactical Tasking and Coordination Group, the document continued.
Penalties for fraud can range from fines to time in prison and expulsion from the performers list.
An NHSCFA spokesperson said: ‘The consequences of proven fraud have included sanctions by professional bodies including expulsion, custodial sentences and substantial recovery payments made under the Proceeds of Crime Act.’
Recovering ‘precious NHS funds’
NHSCFA also announced it would prioritise investigating practice fraud in retaining so-called ‘ghost patients’ – people who may have died or moved away from GP practices but still remain on the patient list – as well as procurement and commissioning fraud.
Through its new plans to tackle fraud across the NHS, the body hopes to recover £5m from fraud losses and save £22m in detected fraud and £100m in prevented fraud, it said.
NHSCFA chief Susan Frith said: ‘By preventing fraud, through identifying it and tackling it effectively where it occurs, and by seeking to recover moneys lost to fraud we can ensure that precious NHS funds are used for their intended purpose of patient care.’
NHSCFA said it hopes to ‘to engage with the sector and discuss the ways we can work together to prevent NHS fraud’.
The NHS body will use ‘targeted articles and conference attendance’, such as the 2019 Pharmacy Show, to increase the reporting of fraud in community pharmacy, it said.