Fraud in this area is generally considered to be the manipulation of NHS income streams by practitioners or staff members. It could also be considered activities that violate NHS contractual terms for practitioners and services provided.
As a result of national lockdown regulations there were reduced opportunities to obtain recreational drugs in Europe. Therefore, the European Monitoring Centre for Drug Addiction (EMCDDA) reported an increase in the use of prescription drugs at the beginning of the COVID-19 pandemic. Organised crime groups (OCG) activity in this area could have been fuelled by the increase in demand and will potentially continue under normal social settings due to the additive nature of these drugs. It is therefore a realistic possibility that OCGs operate in the onward supply or sale of prescription medication. Intelligence suggests non-existent or deceased patient details have been used by GPs when prescribing medication for onward trade. OCGs may fraudulently obtain prescriptions, or even collude directly with GPs themselves.
vulnerable from an expenditure of £10.1 billion
It is likely that a small minority of GPs could manipulate their contracts to increase profit. The reliance upon GPs to ensure accurate record keeping and declarations to secure funding potentially enables manipulations. For example, keeping accurate patient lists – which account for the majority of income received by a GP practice each year, approximately £159.61 per patient . Additionally, a lack of assurance processes to authenticate patient lists likely allows some practitioners to deliberately fail to remove former patients from their lists, resulting in increased Global Sum payments.
There is a realistic possibility that practice employees may knowingly or unknowingly be complicit in supporting contract manipulations. The staff member may not directly benefit, but could potentially register ghost patients, or intentionally fail to remove patients from surgery lists.
As the country moves towards living with COVID-19, an increase again in face-to-face appointments with patients is highly likely. This could see an increase in reporting within this area due to patients being present, seeing and reporting activity themselves.
Information reports received for General Practice (GP) contractors
The financial amount vulnerable to GP contractor fraud increased this year because a 1% fraud rate is applied to the total spend. Therefore, as the budget increased so did the estimated loss. This loss is based on the results of a loss analysis exercise completed in 2018/19 where a fraud rate between 1%-3.5% was determined, as the budget increased so does the estimated loss. Reporting also increased this year, with the predominant theme determined to be the submission/ creation of false claims, some of which relate to COVID-19 vaccine.
increase in reporting compared to last year
The change in the number of fraud reports (allegations) received in relation to General Practice (GP) contractors from 2017-18 to 2021-22:
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