2022007

Information requested

1. The total number of reports you have received of potential fraud undertaken by community pharmacy contractors between March 1, 2020 and February 11, 2022/the current date.
2. Of the reports received between March 1, 2020 and February 11, 2022/the current date, the number that have so far been converted into cases.
3. Of the reports converted into cases, the number of cases that currently remain open.
4. Please can you supply details of the incidents described in points 1 and 2, including:
   1. A breakdown of the types of reports of potential fraud undertaken.
   2. The outcome of reports converted into cases.

NHSCFA response

1. From 01/03/2020 to 28/02/2022 NHS Counter Fraud Authority received 283 reports of potential fraud undertaken by community pharmacy contractors.
2. Of these 33 have been converted into cases (although there are only 32 cases, two reports have been converted into the same case).
3. Of these, 25 remain open.
4. Of the 283 reports received
   • 140 relate to dispensing irregularities
   • 25 relate to false claims for allowances and expenses
   • 25 relate to false claims submitted for patient exemption
   • 24 relate to false claims for patient services (e.g. MURs etc)
   • 12 relate to dispensing reissued medication
   • 11 relate to false claims for fees incurred for things like Specials, Out of Pocket Expenses etc
   • 4 relate to ghost patients
   • 3 relate to dispensing medication at one pharmacy but submitting the claim for payment at another pharmacy
   • 2 relate to dispensing counterfeit medication
   • The remaining 37 reports don’t fall into any of these categories and are classed as “other”.
   • The outcome of closed cases is as follows:
     • 2 cases - No Fraud Identified
     • 2 cases - No outcome recorded
     • 3 Cases - No fraud found or proven.