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pharmacy fraudSeptember 30 2015

A report has suggested that fraud involving NHS pharmaceutical services in England could amount to £83 million each year. If the calculations are extrapolated to the healthcare global average fraud loss rate, the figure would be higher at £96 million.

The figures come in a report published by the accountant and business advisory firm PKF Littlejohn. To estimate the level of fraud, the report says that £2.1 billion was spent on Pharmaceutical Services (PhS) in the NHS in England in 2013-14. In addition, six NHS loss measurement exercises looking at the cost of fraud found an average rate of 3.97% in PhS. “If we apply this 3.97% percentage to PhS expenditure, fraud losses would equate to £83 million.”

It cites one example where a pharmacy contractor was claiming to dispense a much greater volume of medicines than was actually occurring, obtaining over £200,000 fraudulently.

While recent data on patient prescription charge fraud has not been published, a PKF Littlejohn refers to a Daily Mail report in December 2014 which suggested the figure was around £237 million. “It is not known how the Daily Mail obtained this information but there is no record of it having been challenged by the Department of Health. It would therefore not be unreasonable to accept this figure of loss for 2013-2014,” says the report.

Estimated levels of fraud in other NHS sectors include potentially £348 million in general practice, £121 million in dental practice, £12.9 million in general optical services, £555 million in NHS Payroll, and potentially £1.27 billion in procurement. Overall, the report suggests total losses to the NHS could be between £3.73 billion and £5.74 billion.

The report has been written by Jim Gee, Head of Forensic and Counter Fraud Services at PKF Littlejohn, and Professor Mark Button, Director of the Centre for Counter Fraud Studies. Mr Gee is the former CEO of the NHS Counter Fraud Service.

“In the UK, the NHS is under financial pressure as the cost of treatment rises faster than inflation and the resources that can be devoted to it. The good news from the report is that there are several examples cited where the cost of fraud (and healthcare fraud) has been reduced – by up to 40% within 12 months. Indeed the NHS itself achieved such reductions between 1998 and 2006, but the situation has now worsened again,” say the authors.

“In the age of austerity, this report is intended as a contribution to a proper debate about how healthcare organisations can manage and minimise the cost of fraud and free up resources for better patient care.”

In response, a BBC report quotes Department of Health spokesperson as saying: “We do not recognise the figures in this highly speculative report which is full of inconsistencies. We are determined to stamp out fraud in the NHS through better information sharing to prevent and deter fraud and we are working with NHS Protect on crime risks and trends to do even more in the future.”

Link:

PFK Littlejohn announcement and link to report              

BBC report         

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