Information requested
The total number of reports you have received of potential fraud undertaken by community pharmacy contractors between January 1, 2021 and June 30, 2023/the current date.
Of the reports received between January 1, 2021 and June 30, 2023/the current date, the number that have so far been converted into cases.
Of the reports converted into cases, the number of cases that currently remain open.
Of those cases that were closed, the number that led to prosecutions.
Of those prosecuted cases, the number that were successful (i.e. returned a guilty verdict).
Of the successful cases, the value of the fraud detected.
Please can you supply details of the incidents described in points 1 and 2, including: A breakdown of the types of reports of potential fraud undertaken. The outcome of reports converted into cases Successful prosecutions of those converted into cases.
NHSCFA response
The total number of reports you have received of potential fraud undertaken by community pharmacy contractors between January 1, 2021 and June 30, 2023/the current date.
Between 1/1/2021 and 30/6/2023 NHS Counter Fraud Authority received 317 reports of potential fraud undertaken by community pharmacy contractors.
Of the reports received between January 1, 2021 and June 30, 2023/the current date, the number that have so far been converted into cases.
Of these 51 have been converted into cases.
Of the reports converted into cases, the number of cases that currently remain open.
Of these, 32 cases remain open.
Of those cases that were closed, the number that led to prosecutions.
None of the cases closed have led to prosecutions.
Of those prosecuted cases, the number that were successful (i.e. returned a guilty verdict).
Not Applicable
Of the successful cases, the value of the fraud detected.
Not Applicable.
Please can you supply details of the incidents described in points 1 and 2, including: A breakdown of the types of reports of potential fraud undertaken. The outcome of reports converted into cases Successful prosecutions of those converted into cases.
Of the 317 reports received:
147 relate to dispensing irregularities.
30 related to false claims for patient services (e.g.MURs etc).
24 relate to false claims for allowances and expenses.
19 relate to false claims submitted for patient exemption.
14 relate to dispensing reissued medication
13 relate to false claims for fees incurred for itmes such as Specials, Out of pocket expenses etc.
4 relate to ghost patients.
2 relate to dispensing medication at one pharmacy but submitting the claim for payment at another pharmacy.
2 relate to NHS medicine being sold abroad at profit or non NHS medication sourced from abroad at lower cost.
1 relates to dispensing counterfeit medication.
The remaining 61 reports don’t fall into any of the above categories and are categorised as ‘other’.