Dental contractor fraud

The COVID-19 pandemic resulted in the suspension of routine dental treatment, however, contractors continued to receive payments to the full contract value. These restrictions would have continued to impact Units of Dental Activity (UDA) behaviour during 2021 – 2022, and as such, estimated financial vulnerability does not demonstrate UDAs pre-pandemic. However, for this reporting period, the decrease in financial vulnerability is assessed due to a reduction in total expenditure and the number of dental contractors.

It has assessed a realistic possibility that some contractors may be encouraged to fraudulently submit claims to meet or exceed quotas, due to pressure to meet pre-pandemic activity levels and avoid clawback of funds for underperformance of the contract.

It is likely that some contractors may manipulate activity through altering patient data and UDAs claimed to secure additional funding. These claims may be for treatments or services not delivered or clinically needed. Additionally, it is also likely that double income occurs where claims to the NHS are submitted for patients who have already paid for private treatment or claims for charge paying patients submitted as exempt.

Practice employees could be complicit in fraudulent practice and conceal for the benefit of the practice or contract holder. Pressure from contractors or lead practitioners could be placed on practice staff to endorse fraudulent activity or obey instructions.

There is also potential for patients to act in collusion with dental performers to receive free or reduced cost treatment, such as the dentist claiming the patient is exempt or accepting a reduced cash cost. This may extend to unwitting complicity from the public due to a lack of understanding of how dental treatment and charges should operate.

This reporting period has seen implementation of dental contract reforms including changes to payment rates and UDA values. This could impact claiming behaviour and financial vulnerability within this thematic area.

Information reports received for dental contractor fraud

There were 78 reports of dental contractor fraud this reporting period, an 11% decrease from 2021 – 2022. Reporting is at its lowest in the past five years and 28% lower than in 2018 – 2019. Aside from 2020 – 2021, reporting has also decreased annually.

The decrease in reporting levels is assessed linked to the reduction in dental services provided, as well as the temporary contractual agreements introduced during the pandemic. However, this may increase once there is an extended period of business as usual beyond the pandemic restrictions.

The change in the number of fraud reports received in relation to dental contractors from 2018 – 2019 to 2022 – 2023 is illustrated in the below chart:

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