Tomorrow's Pharmacist
2007:44-45
January 2007

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Raising fraud awareness in the NHS

When you are a pharmacist you may be handling paperwork that will enable you to make financial claims from the NHS. Most pharmacists are honest, but there is a small minority who try to defraud the NHS of its valuable resources. Ahmer Kunwar describes how fraud is being tackled in the NHS and how you can help

Over the past three years, NHS counter-fraud specialists have organised highly successful events at health organisations throughout England and Wales, raising awareness of fraud among NHS staff and the public.

Last year, during fraud awareness month (9 November–9 December 2006) local counter-fraud specialists (LCFSs) identified and targeted those areas within their health organisations where fraud awareness was thought to be low and began to take action to develop an anti-fraud culture. LCFSs, who are responsible for carrying out all work to counter fraud and corruption in their health organisations, led the campaign on a local level.

They conducted a range of activities to:

• Raise the level of fraud awareness among professionals within the NHS

• Provide information on how NHS professionals can report suspicions of fraud

• Illustrate the role that NHS professionals can play in preventing fraud

The LCFSs conducted seminars to deliver presentations to NHS staff and professionals in their local trusts. They also handed out leaflets to staff and patients, placing messages on local intranet sites and featuring articles in staff newsletters. In addition, a poster campaign was developed to heighten the awareness.

The NHS Counter Fraud Service (CFS) has found some signs of fraud in many areas of the NHS, with pharmaceutical fraud being no exception. Pharmaceutical fraud has been committed by patients, hospital prescribers, hospital dispensers, dispensing doctors, GPs, community pharmacists and appliance contractors.

The case study (see Panel below) gives an example of pharmaceutical fraud perpetrated against the NHS and subsequent action taken by the NHS CFS. The NHS CFS hopes that by taking tough action it will deter potential fraudsters from carrying out such offences.

With a clear understanding of the risks faced by the NHS and a wealth of experience in this area, the NHS CFS can recognise where a process is susceptible to fraud. Once it recognises that a weakness exists, it can take measures to prevent it from happening again.

Most pharmacists are honest, but there is a small minority who try to defraud the NHS of its valuable resources in various ways. Some of these include making false endorsements on a prescription sent to the Prescription Pricing Division, claiming for drugs not dispensed, under-dispensing, abusing the repeat prescribing system, retaining and not declaring paid prescription charges on low cost drugs, and illegally importing or exportating of prescription drugs. Fraud has also been detected among patients who try to pass stolen prescription forms, engage in counterfeiting and forgery of prescriptions and use multiple identities or registrations to obtain drugs.

By working together to reduce fraud and corruption to a minimum, and holding it there permanently, counter-fraud services can release these resources for better patient care. LCFSs and the NHS CFS can, more than ever before, protect vital NHS resources but to do so it is essential that people report any suspicions that they have.

It is difficult to produce a model to address all types of pharmaceutical fraud but the NHS CFS encourages all NHS staff and contractors to undertake regular reviews of prescribing and dispensing trends, and to review procedures and contracts annually. Should any suspicions be identified during the reviews they should be reported to the LCFS.

The NHS CFS has already achieved a great deal by raising awareness about fraud and sharing best practice. Between 1999 and 2005:

• It has provided a total financial benefit of £675m to the NHS — a phenomenal 13:1 return on investment

• It has cut overall losses in the area of patient fraud by 54 per cent from £171m to £78m a year

• It has had a remarkable 96 per cent success rate for prosecution

• Over 1,400 fraud awareness presentations have been delivered to key NHS staff

• Over 980,000 NHS staff and professionals have been covered by counter-fraud charter agreements to work with the NHS CFS to counter fraud and corruption

Reporting NHS fraud

Those who suspect NHS fraud should report it to their LCFSs or call the
NHS fraud and corruption reporting line
tel 0800 028 40 60

All calls will be addressed by trained staff and investigated. Telephone lines are open weekdays from 8am–6pm.

Fraud may also be reported by sending an e-mail to nhsfraud@cfsms.nhs.uk