The Pharmaceutical Journal
Vol 269 No 7218 p471
5 October 2002

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Scottish investigators say many exemptions falsified

Community pharmacists, general practitioners, dentists and opticians in Scotland may be falsifying a third of the prescription and treatment charge exemption checks they are supposed to carry out.

The Scottish Fraud Investigation Unit's annual report for 2001–02 says that checks made where contractors claim to have seen evidence of exemption entitlement show that no valid evidence could have been seen in up to 35 per cent of cases. This was because there was no valid evidence that could have been produced.

The FIU accepts that false evidence may have been provided, but says that the scale of the problem suggests that this is not often the case.

During the year, the FIU carried out 13 investigations of pharmacy contractors for alleged fraud, six of which were completed. Total identified losses attributable to these investigations were £20,476, of which £14,700 was recovered. Losses attributable to opticians came to £64,548; GP losses came to £15,900. No recovery was made in any of the optical cases and £6,199 was recovered from doctors. Identified dental losses were nil. The fraud unit estimates that its activities save the NHS in Scotland about £110,000 a year.

Frank Owens, chairman of the Scottish Pharmaceutical General Council, commented: "All it takes is a handful of individuals doing something improper for us all to be tarred with the same brush. The SPGC does not condone fraud of any form or description and we are working with the Scottish Executive Health Department to ensure that all processes and procedures are as robust as possible." He added that simplification of the business rules that govern prescription endorsement and pricing would be a great help.

"There could be inadvertent overclaiming by contractors who have not understood the business rules," he said. "In order for the processes to be robust, the rules have to be as transparent as possible so that contractors can understand them in terms of their endorsing of prescriptions."