Pharmaceutical contractor fraud could be costing the NHS in England around £111m each year.
The estimated figure — defined as a “realistic probability” — was revealed in an NHS England report, ‘Tackling fraud, bribery and corruption: economic crime strategy 2018–2021’, published on 16 September 2019.
The report says that examples of pharmaceutical contractor fraud include claiming for prescriptions not dispensed, services not performed and inflated drugs costs.
According to the report, an estimated £1.29bn is lost annually to economic crime in the NHS, which includes clinical commissioning groups, NHS Providers and NHS England itself.
Patient fraud — which includes false exemption claims for prescription fees as well as dental and optical charges —accounts for the largest proportion of this, at an estimated £256.1m each year.
In October 2018, the government announced plans to crack down on NHS fraud, including a commitment to reduce prescription fraud by half.
Describing work currently under way to address fraud, the report refers to “provider assurance activities”, which have been used to “improve the contract management of some advanced services (e.g. medicine use review and new medicine services)”.
The report admits there are “considerable gaps in intelligence with reference to fraud risks in primary care areas”, and says that the economic crime strategy includes plans to narrow these gaps.