The NHSCFA estimates that the NHS is vulnerable to £114 million worth of pharmaceutical contractor fraud each year.
Pharmaceutical contractor fraud relates to false claims for either the dispensing of items or for one of the enhanced services offered at the pharmacy. This could include any of the following instances:
- Where the supply of services to the NHS have been falsified or exaggerated.
- Where Medicine Use Reviews (MUR) have been unnecessarily conducted (to meet pharmacy targets).
- Fictitious claims where patient details have been used to make fraudulent claims.
- False claims relating to allowances and reimbursements.
- Where Out of Pocket Expenses (OOPE) have been inflated or falsely claimed.
For a full list of fraud types in this category, please check Pharmacist or Pharmacy in the fraud definitions.
To assist you on how to spot the signs of pharmaceutical contractor fraud and how to put measures in place to stop this type of fraud, please see below.
- Are false claims being submitted in relation to NHS patients who have already paid the NHS charge themselves?
- Are false claims being made for payment in respect of patient services, which includes Medicines Use Reviews, Appliance Use Reviews, smoking cessation etc?
- Are OOPE being fraudulently claimed? For example, are multiple drugs being procured from the same supplier where these are delivered in one box but individual OOPE claims are submitted?
The director of a family chain of high street pharmacies was sentenced to 16 months’ imprisonment for deliberately overcharging the NHS for medicines at one of his branches.
The pharmacist repeatedly submitted claims for payment to the NHS that falsely stated he had dispensed a more expensive item than he had actually provided to the patients.
The investigation revealed that on numerous occasions, the pharmacist had falsely claimed to have dispensed medicines in liquid form to NHS patients when they had in fact received tablets. Drugs in liquid form cost significantly more. Some tablets for dementia such as Memantine and Donepezil cost as little as £3 but the pharmacist claimed for the more expensive liquid formulation, which sometimes cost the NHS as much £300 each time.
In this case alone, over 1,500 prescriptions had been falsely claimed for, costing the NHS a total £76,475. The pharmacist repaid this amount in full and admitted to the offences in a pre-prepared statement.
The pharmacist abused his position to deliberately defraud the NHS over an extended period.
How to report fraud
Report any suspicions of fraud or attempted fraud to the NHS Counter Fraud Authority online at https://cfa.nhs.uk/reportfraud or through the NHS Fraud and Corruption Reporting Line 0800 028 4060 (powered by Crimestoppers). All reports are treated in confidence and you have the option to report anonymously. You can also report to your nominated Local Counter Fraud Specialist if you are an NHS employee or contractor.