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

The NHS BSA is looking for a digital company to analyse its pharmacy data over a two-year period
The NHS BSA is looking for a digital company to analyse its pharmacy data over a two-year period

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.

7 Comments
Question: 
How do you feel about the NHS BSA's crackdown on contractor fraud?

Pharma Tron , Community pharmacist

So where is the line drawn between fraud and mere oversight? I'm just asking because I remember when the NHSBSA must have knowingly embezzled millions of pounds of cash through CIP irregularities in the past- offering a bung to Pharmacy contractors to not ask for recounts must be an admission of knowledge of the scale of the NHSBSA defrauding contractors? I know I asked for a twelve month recount for my then two contracts and received a five figure sum back. That was buried wasnt it? Imagine if every contractor asked for 12mths of recounts? Unimaginable- hence why they offered the compensation payment. Dont even start me on expired claims stuck on the spine. Fraud works both ways- I suppose it's not fraud if it's a systematic failure though?!

Ranjeev Patel, Non Pharmacist Branch Manager

A lot of pharmacy owners are now living hand-to-mouth existences due to the government cuts, this initiative to try and expose them as fraudsters just proves the contempt which the government has towards them.

Dodo pharmacist, Community pharmacist

Great- so go after pharmacy contractor fraud, even though there is no evidence of it. Thanks DHSC that really makes me feel great. Why not do something about CCGs robbing contractors of contractually agreed purchase profits with branded generic switching schemes?

Reeyah H, Community pharmacist

Just get on with our new contract please, instead of spending on other new experiments and wasting time. If there has been contractor fraud- are you even surprised with with what the NHS have done to them (not condoning it in ANY way!!). 

SP Ph, Community pharmacist

Looks like the DoHS has loads of cash to throw on things , even when they are not sure of the definite outcomes (SAVINGS) yet no money to spend on improvement of community pharmacy services.

Another Pharmacist, Hospital pharmacist

Maybe the NHS BSA should write open APIs with it's own data, and some APIs that require permission to access.  Access (controlled but transparent) could promote a market of digital services to pharmacies and back to the NHS BSA itself. The data might promote some PMRs to get innovative; some startups might come up wiht analytics and services that NHS BSA had never of thought of so would never have commissioned!

Oliver Staunton, Information Technology

PharmData already uses quite a lot of the NHSBSA data :)

*This comment has been edited to comply with C+D's community principles*

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