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NHS to pay company £750k to crack down on alleged pharmacy fraud

The NHS Business Services Authority (NHS BSA) is offering to pay up to £750,000 for a “predictive analytics partner” to help combat alleged pharmacy fraud.

In a procurement notice posted on the government’s digital marketplace last week (July 4), the NHS BSA calls for a “predictive analytics partner” to help “identify trends, patterns/anomalies in pharmacy payments/prescribing activities”.

The digital partner company will implement “cutting-edge analytical models” to the NHS BSA’s pharmacy data to help the organisation detect alleged contractor fraud, error and waste, as well and “predict outcomes” in future, the NHS BSA explained to C+D.

The start date for the project is September 2019 and the contract is expected to last for two years, with the maximum payment being £750,000 for the whole period, excluding VAT, according to the procurement notice.

A C+D investigation last year revealed that evidence of pharmacies actually committing fraud remains negligible (see below).

“£100m lost to contractor fraud”

When asked by C+D whether partnering with the digital company will help save the NHS money, the NHS BSA said: “It is not known at this stage.”

The NHS CFA estimated that £108 million is lost annually to “pharmaceutical contractor fraud”, in its 2019 strategic intelligence assessment.

However, this estimate should be “treated with low confidence”, it admitted in the document.

“Benchmark” pharmacy owners against peers

One intended outcome of the project is to “benchmark NHS contractors” to make them “aware of how they compare to peers”, the NHS BSA explained.

The project will “focus on error and waste” as well as fraud, and “highlight areas for improvement within patient or contractor activity”, it added.

Pharmacy fraud allegations: a recent history

In June, the NHS’s Counter Fraud Authority (NHS CFA) told C+D of plans to step up investigations into fraudulent expenses claims by pharmacy contractors across England.

This followed the Department of Health and Social Care's (DH) 2018 “drive” to uncover pharmacists claiming payments for services they have not carried out.

It claimed at the time that “large-scale scams” by “a minority of pharmacists and dentists”, were “impacting heavily” on the total fraud bill in England.

However, a freedom of information request by C+D later revealed that the DH was unable to provide compelling evidence of large-scale fraud occurring in the sector.

How do you feel about the NHS BSA's crackdown on contractor fraud?

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