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Bournemouth and Poole PCT / Dorset PCT LPC Presentation. FRAUD & CORRUPTION IN THE NHS. Steve Plant / Patrick Kelly Local Counter Fraud Specialists Dorset & Somerset Counter Fraud Service. Introduction. £ M’s lost to fraud, corruption and error

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    1. Bournemouth and Poole PCT / Dorset PCT LPC Presentation FRAUD & CORRUPTIONIN THE NHS Steve Plant / Patrick Kelly Local Counter Fraud Specialists Dorset & Somerset Counter Fraud Service

    2. Introduction £M’s lost to fraud, corruption and error • Majority of staff, contractors and patients are honest – small minority are not • Deprived of valuable resources which should be spent on patient care • Examples of fraud range from false travel claims by staff to complex and high value fraud

    3. WHAT IS FRAUD? 3 elements to committing fraud: • A dishonest act (or failure to act) • With intent • To make a gain or causing a loss • Does not have to be successful • Does not have to be personal gain

    4. WHAT IS FRAUD According to the law (Fraud Act 2006): • s.2 By false representation • s.3 By failing to disclose • s.4 by abuse of position of trust (corruption)

    5. Who commits fraud? Four main groups of people: • Staff • Patients • Contractors (GPs, pharmacists etc) • Suppliers of goods

    6. Main types of fraud • Timesheet fraud: • bank, overtime, enhancements • Working elsewhere whilst sick • Obtaining drugs by deception • Procurement fraud (corruption) • Invoicing for goods not provided • Claiming for services not provided

    7. Patient Fraud • False Registration • Temporary or permanent • Fraudulently obtaining duplicate scripts • Original ‘lost’ or ‘stolen’ • Theft of blank prescriptions • Altering prescriptions • Adding items or changing quantity • Claiming false exemption from charges

    8. False Identity Fraud • A Gosport woman made over 200 false temporary registrations over 4 years. • Using different identities, obtained Co-Drydamol to feed her addiction. • Convicted in 2004 and again in 2005 for obtaining drugs by deception from Hampshire GPs, • Moved area of operation to Dorset and then Isle of Wight. • Convicted again in May 2008 and received an 18 months supervised community sentence.

    9. Theft and forgery ofprescriptions • Patient arrested and admitted stealing prescriptions • Scanned stolen blank prescriptions to set up a template on his PC at home • Generated prescriptions for Dihydrocodeine and Lorazepam • Charged with theft and two charges of obtaining property by deception • Given an 18 month Community Rehabilitation order

    10. GP obtained drugs by fraud • A GP forged prescriptions to obtain drugs • He presented a prescription to pharmacy in his son’s name • Issued 22 prescriptions for codeine phosphate and dihydrocodeine in names of various patients • All the drugs collected by the GP but patients never received medication • 18 other offences taken into consideration • Suspended by the PCT • Pleaded guilty, fined £3,000 and ordered to pay £250 in compensation

    11. Pharmacy Reward Scheme • Details of stolen prescriptions are circulated by the PCT • Potentially altered or forged prescriptions should be checked with the prescriber • Pharmacists are advised to phone the police if a patient presents a stolen, altered or forged prescription • May be eligible for a £70 reward

    12. Pharmacy Reward Scheme • Part XIV of the Drugs Tariff • Pharmacist’s are eligible for a £70 reward if: • The fraudulent prescription is withheld & the drugs are not dispensed, • OR The fraudulent prescription is dispensed but the Pharmacist had a genuine reason for dispensing the medication, • AND The PCT is advised as soon as possible, • AND NHS CFSMS are advised within 7 days and a claim is made within 28 days

    13. Patient Verification Service • Patients required to show proof of exemption from payment of prescription charge e.g. • Award letter from DWP for a relevant benefit: • Income Support, or • Income based Job Seekers Allowance, or • Income based Employment and Support Allowance • NHS tax credit exemption certificate • Valid HC2 certificate • FP96 pre-payment Card

    14. Patient Verification Service • Only certain benefits give exemption • The following DO NOT exempt patients from charges: • Incapacity Benefit • Disability Living Allowance • Contribution based Job Seekers Allowance • Contribution based Employment and Support Allowance

    15. Patient Verification Service • Pharmacy should request evidence of exemption • If not provided, the back of the prescription should be marked with an X • These may be checked at a later date by the Patient Verification Officer at Counter Fraud Service • If patient found to have falsely claimed exemption a penalty charge will be issued

    16. Patient Verification Service • Civil Fine • 5 times the amount owed up to a maximum of £100 • In addition to the original charge • 50% surcharge (Penalty only) • Repeat offenders may be prosecuted

    17. Pharmacy Fraud • A Leeds Pharmacist received payment for prescriptions from patients, but then claimed that the patients were exempt from charges so he could recoup the money from the NHS • An investigation by NHS Counter Fraud Specialists found that since the pharmacy was purchased in May 2003, there had been a 50% decrease in the number of prescriptions paid for by patients • He was arrested at his pharmacy and later charged with 13 counts of obtaining a money transfer by deception and False Accounting • He pleaded not guilty at Court but was convicted by jury after a two week trial and was jailed for 9 months

    18. Pharmacy Fraud • Pharmacist applied to PCT to take part in their stop-smoking programme • Entitled to claim payment for each consultation and nicotine replacement therapy service he provided, with a bonus if a set quota of participants successfully completed the scheme • An investigation revealed that he had claimed payment for more treatments than he provided, and claimed that some participants had completed the scheme when they had not • One man who he claimed had been provided with NRT and successfully completed the scheme, had never attended his pharmacy • He pleaded not guilty to four counts of false accounting but was found guilty on three counts by the jury, fined £3,000 and ordered to pay £1,500 prosecution costs

    19. Other areas of concern • Medicine Use Reviews • Repeat Ordering Service • Ordering all items on repeat but only dispensing some • Fees for special preparations • Suppliers offering discounts (or kickbacks?) • 7 day prescribing • 28 day calendar packs

    20. Contact Details Steve Plant, Local Counter Fraud Specialist Work Telephone: 01202 851228 Mobile: 07768 144050 E-mail: DSCFS website: Fraud Hotline: 0800 028 40 60 Public Concern at Work: 0207 404 6609