NHS to appoint 600 fraudbusters

THE BIGGEST crackdown on NHS fraud begins today with a campaign to save pounds 150m lost through prescription charge evasion.

Patients claiming free prescriptions will now have to produce evidence of their entitlement in the first stage of a scheme that will eventually see 600 "fraudbusters" appointed throughout the NHS.

The staff for the pounds 4m-a-year scheme will be trained in detection and interview techniques and will target GPs, dentists, opticians and pharmacists involved in expensive scams to defraud the NHS.

No one knows how much the NHS is losing as a result of fraud but it is estimated to run into hundreds of millions of pounds. Jim Gee, the NHS's chief fraudbuster appointed last September, said: "The NHS's budget is pounds 44bn a year and if only 1 per cent of that is going astray that would be pounds 440m. We don't have hard information but it is clear that substantial sums are at stake."

A pounds 1m advertising campaign begins today warning patients and pharmacists that from 1 April those claiming free prescriptions will have to produce evidence of their age or other reason for their entitlement. More than four of five prescriptions are handed out free of the pounds 5.85 prescription charge but only children, those over retirement age, and those on benefits, plus a few smaller groups, are entitled to receive free prescriptions.

A national Counter Fraud Service is being set up with eight regional teams, two specialist teams targeting prescription and dental fraud, and a mobile team.

By March 2000, every health authority will have its own counter fraud specialist and this will be extended to every NHS trust by March 2001, totalling 600 staff.

A survey last year found doctors and opticians involved in fraud were targeting nursing homes because residents were often confused and vulnerable and made poor witnesses when a scam was discovered. Typical schemes involved prescribing new spectacles with stronger lenses to residents every few months and making out prescriptions for drugs that are never delivered.

Other examples included a dentist who claimed payment for extraction of milk teeth from a patient aged 100 and another who claimed for filling, then extracting, then filling again and extracting again, the same teeth in the same patient. A popular fraud among opticians was to claim payment for tinted lenses and then provide plain lenses. The survey, by the Health Care Financial Management Association, found that the average fraud was worth pounds 50,000 and health authorities detected pounds 8m worth, which it said was the tip of the iceberg.

Mr Gee made his name tackling fraud at Lambeth council in south London. His investigations resulted in losses being halved, and led to the sacking of 120 employees. He said: "We know most about fraud in the area of prescriptions and our estimate is that pounds 150m a year is being lost. We want to reduce that by half by 2002-3. We aim to reduce fraud throughout the NHS to an absolute minimum within 10 years."

He said he had been encouraged by the backing he had received for the campaign from medical and pharmaceutical organisations. "The thing that has impressed me most is the enthusiasm of all NHS staff for the work we are undertaking. They are very clear why we are doing it - to free up large sums of money for patient care."