NHS dental services in England are provided by dental practitioners under contract to deliver general care and treatment. Dental contractor fraud concerns the fraudulent claims submitted to the NHS by dentists and their staff members for a range of NHS services provided to patients.
The COVID-19 pandemic resulted in the suspension of routine dental treatment. During the 2020 - 2021 period, contractual agreements stated no financial penalties would be incurred as long as a targeted percentage of Units of Dental Activity (UDA) and Units of Orthodontic Activity (UOA) were achieved.
vulnerable from an expenditure of £2.6 billion
This could have enabled manipulation and encouraged the fraudulent submissions of claims by contractors in order to meet or exceed their quota. Additionally, further fraud could have been enabled due to restricted contact with patients, including the suspension of patient signatures on dental treatment forms which could have allowed for fraudulent claims and reduced patient assurance.
It is highly likely that contractors claimed for treatment against patients who are recently deceased, those who have moved areas or those who received simple treatments; but altered the records to appear as more complex courses of treatment, known as Upcoding. If contractual targets are not met, the contractor could be penalised through the clawback of funds, therefore encouraging false claims.
Practice employees could be complicit in fraud due to the potential consequences of poor performance negatively affecting the practice financially. As the General Dental Service (GDS) contract is commissioned with the lead practitioner, owner or a corporate body, pressure from senior staff or contractors to commit fraud is possible. This is enabled by internal assurance procedures and lack of independent oversight, for example audits of contractor claims are usually performed by the practice manager.
Patients could potentially collude with those performing their treatment to receive it at a free or reduced cost. An exemption from treatment charges could be claimed, whilst paying a reduced cash cost to avoid detection. The performer then goes on to claim a higher banded treatment with the NHS. Alternatively, lack of public understanding of how NHS dental treatment and charges operate results in unknowing complicity.
Looking ahead, possible changes to the NHS dental contract are being discussed with the British Dental Association, although any confirmed changes have not yet been published . As the dental contract dictates precisely how NHS funding and claims are paid, any alterations will greatly impact on potential fraud within this area. The NHSCFA will continue to assess developments in this area.
Information reports received for dental contractors
The decrease in both the financial vulnerability figure and the reporting levels within dental contractor fraud are believed to be linked to the reduction in the dental services provided, as well as the temporary contractual agreements introduced during the pandemic.
The change in the number of fraud reports (allegations) received in relation to dental contractors from 2017-18 to 2021-22:
decrease in reporting compared to last year
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