Dentists 'inventing work to defraud NHS'

 

Martin Hickman
Monday 07 May 2012 17:49
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Dental surgeries are exaggerating or inventing work they have done for the National Health Service in order to swindle tens of millions of pounds out of taxpayers, according to a check up of dentists’ honesty.

Among the rogue practices were submitting false claims for more treatment than had been carried out and submitting claims on behalf of patients do not exist.

Claims for ‘ghost patients’ were the most blatant in a catalogue of illegal practices uncovered by an audit of 5,000 dentists’ invoices examined by NHS Protect, the anti-fraud unit of the health service.

Overall, 3 per cent of claims examined were deemed to be fraudulent, indicating that dishonest dentists defrauded the NHS out of £73.1m in 2009-2010, when the check was made. By 2014, the NHS could lose a further £146.3m unless the deception was halted, the report, Dental Contractor Loss Analysis Exercise, published today.

The Conservatives claimed the losses exposed in the report stemmed from a new NHS contract introduced by Labour in 2006. Labour blamed the dentists for swindling the taxpayer and called for tougher action from regulators.

Under the new dentistry contracts introduced by Tony Blair, dentists were paid by three broad bands of work rather than for each procedure on a long and complex list.

At the time Labour claimed that the move would cut bureaucracy and increase access to dentistry, but many dentists feared they would lose money under the new system and stopped accepting NHS patients. Some 500,000 fewer people visited an NHS dentist in the two years after the contract’s introduction compared with the two years beforehand.

In an attempt to check whether dentists were fraudulently topping up their income by cheating the system, NHS Protect checked claims submitted for the treatment of 5,000 individual patients. Almost 4,200 patients were traced and asked about the work they had done, which was then cross-checked against what their dentist had claimed for.

In 75 per cent of claims, dentists were honest. In a further 22 per cent the claims could not be verified one way or another (often because the patients could not be traced) - but 3 per cent of cases, 157, were categorised as “suspected contractor fraud.”

Half of the frauds, 77 cases, involved dentists charging for more expensive work than they had carried out.

In a further 27 per cent, they had wrongly split the course of treatment into different claims. Almost a quarter of rogue claims were for work that had never done: in 12 per cent the “patient did not visit” the dentist for treatment, while in 10 per cent the “patient does not exist/ghost patient.”

Health Minister, Lord Howe, blamed the problems on Labour – which was in power in March 2010 when the claims examined in the exercise were submitted.

Lord Howe said: “Taxpayers will rightly be appalled at the £70 million price tag they are paying for Labour’s botched stewardship of NHS dentistry. This is money that should be spent on patients. It is a great shame that a minority of dentists have been able to game a complex and confusing contract."

Jamie Reed, Labour's shadow health minister, countered: "Fraud is the fault of the fraudster, not the contract. The Tories are shamelessly playing politics by trying to blame the rules instead of the people who break them.”

Mr Reed called on the General Dental Council and the Department of Health to “get a grip on the small number of rogue claimants.”

The Department of Health said it would introduce a new dental contract which would tackle fraud by streamlining and simplifying payments.

Lord Howe said: “Until then, we will not tolerate any kind of fraud we uncover.”

The Department of Health confirmed that the NHS was taking action against the dentists caught out by the exercise.

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