Freedom of Information request: 2022012
Request summary: Request regarding Methods for preventing and detecting dental contractor fraud.
Request date: 30/04/2022
NHSCFA response date: 24/05/2022
Please may you give me the information on the current methods you use for detecting and also preventing dental contractor fraud for the NHS?
In response to your request, the principal responsibility for the investigation of dental fraud within the NHS lies with NHS England as a primary care issue.
In addition the management of claims and payment systems for dentistry is also part of the NHS England remit, although the NHS Business Services Authority undertake payment processing and provider assurance processes (see NHS Dental Services | NHSBSA, ) as such the majority of preventative measures will be in that area.
The NHSCFA relationship with the sector is defined in the sharing agreement with the General Dental Council:
The NHSCFA do however detect dental contractor fraud through reporting, analysis of data (National Dental Contract data, Personal Dental Services (PDS) contracts, Community Services (CS) contracts) and undertake analysis of the sector as a whole via the Strategic Intelligence Assessment.
There is information on our website about our approaches:
Where fraud is found as part of investigations and a weakness is identified, then recommendations are made to the appropriate authorities to amend their processes.
Current methods for detecting fraud are based on a distinctive problem being addressed, the data and its structure / availability and the tool applied alongside the organisation outcome required.
Therefore, currently rule based analysis is the main approach applied, using domain knowledge to add context to any records identified as irregular from the rules applied. It must be noted no method/algorithm can 100% confirm fraud without an investigation taking place.
In addition, our approach will include several strands:
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