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Pharmacy fraud - fact or fiction?

30 November 2015

Healthcare fraud made the news recently. Accountants PKF produced a report on the financial cost of healthcare fraud. The report said that the pharmacy fraud costs the NHS £83m per year.

The figure of £83m, includes fraud by patients who wrongly claim exemption from prescription charges, and fraud by pharmacists.

The report says fraud by pharmacists includes one case where a pharmacist purported to dispense more than was actually the case, thereby defrauding the NHS of £200,000; and alleges that 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 prescription forms to the NHS Prescription Pricing Division.

Undercover police officers had presented prescriptions for dispensing, and an investigator from the NHS Counter Fraud Service went to the PPD 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 simply failed to spot them.

The figure of £83m is based on a combination of extrapolation and speculation. NHS England’s Annual Report for 2013-14 says that £2.1bn was spent on pharmaceutical services. 3.97% of £2.1bn is £83m.

So where does the percentage of 3.97% come from? PKF says the Department of Health carried out a loss measurement in 2009-2014 and concluded that there had been a loss through fraud of between 2.94% and 3.49%.

The Department of Health’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, you can’t measure it.

This article was originally published in Chemist & Druggist, November 2015.

For more information, please contact David Reissner on +44 (0)20 7203 5065 or at david.reissner@crsblaw.com