Last year, the Department of Health and Social Care (DH) said it would crack down on alleged pharmacy contractor fraud, which it claimed was “impacting heavily” on the total fraud bill for the NHS.
The NHS Counter Fraud Authority (NHS CFA) estimated that £108 million is lost annually to this fraud, in its 2019 strategic intelligence assessment. However, this statistic should be “treated with low confidence”, it admitted at the time.
C+D sent freedom of information (FOI) requests to the NHS CFA, which revealed that 362 reports of contractor fraud in England and Wales were received by the organisation between January 1, 2017 and June 30, 2019.
However, of these 362 reports, just 34 – less than 10% – were ever “converted into cases”. Even more startlingly, only one of these 34 investigations has so far led to a “successful civil sanction”, which the NHS CFA said was settled outside of court.
In seven of the cases, no fraud was found or proven, and one case was dropped due to insufficient evidence. The remaining 26 are still under investigation.
What were the fraud reports about?
The majority (281) of the reports related to “inappropriate dispensing/enhancing services”, while 31 concerned “activities that contravene the terms of the contractual agreement”, 27 were for “inflation of fees, allowances and reimbursements claimed under the drug tariff” and nine for “market abuse”, which refers to behaviour intended to artificially manipulate the market for gain.
The remaining 14 reports were categorised by the NHS CFA as “other”.
C+D's discovery comes just a month after it reported that the NHS Business Services Authority (NHS BSA) is looking to pay a company £750,000 to combat alleged contractor fraud.