The Pharmaceutical Journal
Vol 268 No 7187 p274-79
2 March 2002

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Directorate of Counter Fraud Services (www.doh.gov.uk/dcfs)

Counter fraud crackdown focuses on false "small pack" endorsements

Counter fraud investigators are cracking down on the small number of pharmacy contractors who endorse prescriptions to say that several small packs have been dispensed when one larger one was actually given to the patient. At the same time, the reward scheme for detecting or preventing fraud is to be relaunched.

David Grey, pharmaceutical team leader at the National Health Service Counter Fraud Service in Newcastle, said that "small pack" endorsements were the most common type of investigation in which his team are involved. A typical example of this is when the prescription calls for E45 cream 500g. Some pharmacies have been dispensing the large pack size but endorsing the prescription to the effect that multiple small packs, ie, 10 x 50g, were dispensed.

"We are seeking to bring home the message that contractors should only claim for what is dispensed. Contractors are responsible for the endorsements that are made. If the endorsements are not accurate then that could be fraud. In any case, any overpayments would be recovered," he said.

One pharmacist has already been prosecuted following an investigation by the counter fraud team which confirmed that endorsements were incorrect. The pharmacist admitted the offences and was later sentenced to 100 hours community service and agreed to repay £20,000 which had been obtained fraudulently. Mr Grey said that around a dozen similar prosecutions were pending with one new case being added each week. All investigations are pursued on a "triple track" approach, looking at criminal, civil and disciplinary cases for each one.

Many contractors are using computer systems that automatically endorse prescriptions. Mr Grey said that contractors were responsible for what these systems did. A meeting is to be held with system manufacturers to discuss issues surrounding endorsement and fraud.

John D'Arcy, chief executive of the National Pharmaceutical Association, said that while individual cases had to be judged on their merits, the issue highlighted just how complicated the whole system of endorsement and remuneration had become.

"The remuneration system is riddled with inconsistencies and inequities," he said.

The fraud service will shortly be launching a telephone support line to assist pharmacists in making point of dispensing checks. This will give advice on, for example, the different types of identity documents that can be used to support claims for exemption from prescription charges, or allow other organisations, such as the police or Benefits Agency, to become involved in an investigation. The introduction of point of dispensing checks has reduced fraud by patients by 41 per cent, saving £48m, according to Counter Fraud Services.

The relaunched reward scheme offers a basic award of £10 or 10 per cent of the NHS price, whichever is greater, for not dispensing a fraudulent prescription. There is also a bonus award where information that is provided by a contractor leads to savings being made by preventing further frauds. The reward for this amounts to £10,000 or 5 per cent of the savings made, whichever is less.

To date, 772 claims have been made for rewards. Of these, 554 have been paid so far, including 35 bonus awards.

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