The Pharmaceutical Journal Vol 263 No 7066 p558
October 9, 1999 News

PSNC takes advice over PPA "fraud"

The Pharmaceutical Services Negotiating Committee is taking legal advice over the Prescription Pricing Authority's treatment of some prescriptions, which the committee says is "tantamount to fraud". What the PPA is doing that the PSNC objects to is taking prescription forms from contractors' bundles of charge exempt forms and treating them as forms on which prescription charges have been collected, because the exemption declarations have not been properly signed. Contractors lose £5.90 from their NHS reimbursement for each item on a prescription form that is treated in this way. The committee has also accused health authorities of being unhelpful towards contractors who believe that they have been denied proper payment. Speaking at a press briefing on October 4 after the PSNC's September meeting, Mr Wally Dove (chairman, PSNC) explained that this was nothing new, but that it was now coming to a head.

The PSNC believes that contractors may be losing large sums of money because of improperly completed exemption claims

"This has been gaining quite a head of steam over the past couple of years. The introduction of point-of-dispensing exemption checks has focused contractors' attention even more on it," he said.
"If the PPA is knowingly switching prescriptions, especially age-exempt prescriptions, which can be easily validated by the date of birth or age on the front of the forms, we think that this is verging on fraud. There is no possibility that contractors could have taken payment from these patients."
Mr Stephen Axon (general secretary, PSNC) added that the PSNC and the Department of Health were both of the view that contractors who were aware that they might have been denied payments due were entitled to inspect their priced prescription bundles at health authority premises. If a contractor could then show that he had not been correctly paid the authority was obliged to correct the matter.
In this regard, there were reports that some health authorities were being unco-operative, Mr Dove said. The National Health Service Executive was now to be asked to discontinue the practice of prescription switching so far as age-exempt forms were concerned.

Correction
The Prescription Pricing Authority has said that it would have accepted the prescription used to illustrate this report on prescription switching because the patient declaration contained a full name and address.