Revealed: No prosecutable fraud cases against pharmacy contractors since 2021
A C+D investigation has revealed that no fraud reports lodged against community pharmacy contractors have been converted into prosecutions by the NHS fraud office in over two years.
The NHS Counter Fraud Authority (NHSCFA) told C+D last week (July 20) that it has not found any prosecutable cases among community pharmacy contractors in the last two-and-a-half years.
Responding to a freedom of information (FOI) request submitted by C+D, the NHSCFA said that it had received 317 reports of potential fraud undertaken by community pharmacy contractors between January 1 2021 and June 30 this year.
Of those, just 51 (16%) had been converted into cases – 32 of which remained open – it said.
None of the closed cases had led to prosecutions, it revealed.
Since no fraud allegations have led to prosecutions, let alone successful prosecutions, no community pharmacy contractor fraud was detected in that period.
It comes as the Department of Health and Social Care (DH) last month released its latest counter-fraud strategy document, which set out that pharmacy contractor fraud had been chosen as a priority area for 2023-2026.
And the NHSCFA’s strategic assessment for 2022 – published in July last year - claimed that £122 million was "vulnerable" to pharmacy contractors.
Types of fraud allegations
The NHSCFA also divulged the nature of the 317 fraud reports that it received against community pharmacy contractors.
It told C+D that:
- 147 regarded ‘dispensing irregularities’
- 30 regarded false claims for patient services (such as medicines use reviews)
- 24 regarded false claims for allowances and expenses
- 19 regarded false claims submitted for patient exemption
- 14 regarded dispensing reissued medication
- 13 regarded false claims for fees incurred for items such as specials or out-of-pocket expenses
- Four regarded ‘ghost patients’
- Two regarded dispensing medication at one pharmacy but submitting the claim for payment at another pharmacy
- Two regarded NHS medicine being sold abroad at profit or non-NHS medication sourced from abroad at lower cost
- One regarded dispensing counterfeit medication
- The remaining 61 reports did not fall into any of the above categories
The NHSCFA’s approach to community pharmacy contractor fraud has previously come under scrutiny.
For several years, lawyer David Reissner has written critically about the fraud authority. Most recently, he wrote last month about its estimates of £122m pharmacy contractor fraud in 2022, saying that “the NHSCFA is just plucking a figure from the air to justify its existence”.
Mr Reissner questioned whether the NHSCFA was providing value for money and whether data on “the number of prosecutions in a criminal court and the outcomes of prosecutions” would back up its claims. As C+D’s FOI shows, the number for over two years is nil.
In September 2019, Mr Reissner provided an analysis of why he believed the NHSCFA’s then-figure of £111m pharmacy contractor fraud was “bogus” and the previous year, he wrote that he was “suspicious” of the data being used to estimate pharmacy contractor fraud.
A C+D investigation previously revealed in November 2018 that despite NHSCFA claims of widespread fraud in community pharmacy, scant evidence of recent fraud could be produced to support its estimates.
The most recent pharmacy contractor fraud case covered by C+D was in October 2019, when the co-director of five pharmacies in South Wales was jailed for 16 months after deliberately overcharging the NHS £76,000 for 1,500 “tampered” prescriptions.
According to its latest annual report, published earlier this month (July 13), the NHSCFA receives over £14m in parliamentary funding, £10m of which is spent on staff costs.