Information requested

I would like to know:

  1. In total, how many of the reports received by the NHSCFA from January 1st 2017 - June 30th 2019 were of fraud undertaken by community pharmacy contractors?
  2. How many of the total number of the community pharmacy contractor fraud reports received in January 1st 2017 - June 30th 2019 were due to:
    1. Inappropriate claims relating to dispensing and enhances services offered at the premises
    2. Inflation of fees, allowances and reimbursements claimed under the drug tariff
    3. Activities that contravene the terms of the contractual agreement
    4. other (please specify)
  3. The data underpinning NHSCFA’s decision to investigate community pharmacy contractor fraud as a priority
  4. The estimated cost to the NHS of community pharmacy contractor fraud in 2017-2019.

NHSCFA response

Reports received relating to Pharmaceutical Contractor Fraud from 1st January 2017 to 30th June 2019:

Fraud and Corruption Reporting on Line Reporting via Local Counter Fraud Specialists
Total Reports 362 275 87
Inappropriate Dispensing /Enhancing Services 281 226 55
Inflation of Fees 27 9 18
Contract 31 23 8
Market Abuse* 9 4 5
Other 14 13 1

*The category of ‘Market Abuse’ refers to concerns about inappropriate behavior intended to artificially manipulate the market for gain.

In response to points 3 and 4, the information is accessible in the NHS Counter Fraud Authority Strategic Intelligence Assessments 2016-17 and 2017-18,

Strategic Intelligence Assessment 2016-17

Strategic Intelligence Assessment 2017-18

The findings for the period 2018-19 will be included in the next Strategic Intelligence Assessment. It is the intention of NHS Counter Fraud Authority to publish this assessment at a future date, therefore under Section 22 of the Freedom of Information Act 2000 this information is exempt from disclosure.