The NHSCFA and the NHS Business Services Authority will share pharmacy data to identify “potential fraud by contractors”, it said in its business plan for 2019-20.
Pharmacy investigations will focus on “analysing the claims that are made for additional payments beyond the price of the drugs supplied”, the NHSCFA told C+D yesterday (June 13).
It used the example of “out-of-pocket expenses” claimed to cover the costs of sourcing a drug that the pharmacy does not regularly dispense, including courier costs.
While “most of these claims” are legitimate, the NHSCFA believes “there may be claims that are not”, it added.
“Drive to increase sanctions”
A crackdown on fraud in relation to pharmacy owners is identified as one of the authority’s “priority action areas” – along with GPs fraudulently claiming for “ghost patients” – as it looks to detect £22 million of fraud in the NHS, prevent £100 million and recover £5 million from fraud losses in 2018-19.
To help realise these savings, “there will be a drive to increase the number of sanctions imposed” and improve the quality of referrals to police and other crime prevention agencies as appropriate, the NHSCFA said in its report.
“If an outlier is found while analysing the data, we will determine why the outlier exists and if appropriate, it will be investigated further,” the NHSCFA told C+D.
The penalty for a contractor found to be fraudulently claiming additional expenses ranges from a fine to criminal prosecution.
Pharmacy fraud claims
Last year, the Department of Health and Social Care (DH) announced a “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.