Healthcare fraud made the news recently following the publication of a report from accountants PKF Littlejohn. Pharmacy fraud, it says, costs the NHS £83 million per year and includes fraud by patients who wrongly claim exemption from prescription charges and fraud by pharmacists.
The report cites one case in which a pharmacist purported to dispense more than was actually the case, thereby defrauding the NHS of £200,000. It also alleges that some pharmacists claim for services they have not provided, and withhold prescription forms for low-value items so as to pocket the prescription charges from non-exempt patients. But, unless someone has been found guilty by a court or a fitness-to-practise committee, these are just unfounded smears.
I once represented a pharmacist who was accused of keeping prescription charges and not sending the forms to NHS Prescription Services (NHS PS). Undercover police officers had presented prescriptions for dispensing and an investigator from the NHS Counter Fraud Service went to NHS PS each month to check if the forms had arrived.
Over a six-month period, the investigator found 36 out of 45 forms. My client was prosecuted for withholding the charges paid on the remaining nine forms. A Crown Court judge kicked the case out, because it was obvious that the forms could have been there all along and the investigator had simply failed to spot them.
The figure of £83m is based on a combination of extrapolation and speculation. It has taken the reported spend on pharmaceutical services in NHS England’s Annual Report & Accounts 2013-14 and applied a fraud rate of 3.97% to calculate £83m.
So where does the 3.97% come from? PKF says the figure is informed by six NHS loss measurement exercises. One of these was a reported Department of Health (DH) loss measurement exercise in 2009-2014 that concluded there had been a loss through fraud of between 2.94% and 3.49%. The DH’s findings have not been published, but the Daily Mail wrote about a leaked copy. PKF says that, since there is no record of the Daily Mail article having been challenged, it is not unreasonable to accept the estimated loss figure. This is the same reasoning that might lead you to believe that in his youth, the Prime Minister did something unmentionable with a pig’s head.
The only things we can say with certainty are that people can be wrongly accused of fraud and, if a fraud goes undetected, it is impossible to measure.
David Reissner is senior healthcare partner at law firm Charles Russell Speechlys ([email protected])