Community Pharmaceutical contractor fraud

Fraud relating to inappropriate claims for dispensing and enhanced services offered by community pharmacies, inflated claims under the drug tariff or activities that contravene contractual terms.

Pharmaceutical Contractor fraud involves the Falsification or Exaggeration of Services, as well as collusion.

Due to the COVID-19 pandemic, temporary suspensions were introduced for patient signatures on prescriptions and for the consent required from patients for electronic repeat dispensing. Additional income was also offered to pharmacists dispensing over a certain threshold. Therefore, it is likely that some pharmacists exaggerated their activities to receive higher monthly payments, including claims for the uncollected prescriptions of university students or over prescribing in bulk for care homes.

£122m

vulnerable from an expenditure of £12.2 billion

COVID-19 also provided an opportunity to allowed some pharmacists to claim for ‘ghost patients’ within the vaccination programme and to intentionally split transactions when supplying NHS Lateral Flow Device (LFD) home testing kits . Additionally, during the height of the pandemic, it is likely that a number of pharmacists could have used volunteers to deliver prescriptions to shielding patients or falsified deliveries entirely , but still claimed reimbursement for an outsourced delivery.

The intelligence suggests that a small minority of pharmacists may have offset revenue shortfalls by claiming reimbursement for COVID-19 related upgrades which were not undertaken . Reports suggest that some pharmacists could have delayed the submission of claims for drugs dispensed to receive a higher reimbursement. Enabled by the monthly price fluctuation being advertised in advance .

Finally, there is a realistic probability that pharmacists and manufacturers will potentially collude to mutually increase profits. Reports suggest that some manufacturers could have charged an excessive amount for a pharmaceutical special item and then split the profit . Others are believed to have made ‘kickback’ payments to pharmacists in exchange for ordering products from them above alternative manufacturers. From 01/04/22 the government will cease to provide universal symptomatic and asymptomatic testing to the general public for free, therefore a decrease in NHS LFD related manipulations is expected.

Information reports received for Pharmaceutical contractors

Reporting may have increased due to the introduction of various new processes which were required during the pandemic, for example those relating to LFDs, COVID-19 vaccines and prescription deliveries. Similarly, the financial figure vulnerable to fraud may have experienced a legitimate increase because of these new revenue streams, as well as potentially exaggerating those certain costs.

8.39%

increase in reporting compared to last year

The change in the number of fraud reports (allegations) received in relation to Pharmaceutical contractors from 2017-18 to 2021-22:

2017 to 2018 2018 to 2019 2019 to 2020 2020 to 2021 2021 to 2022
138 182 160 140 155