An investigation into three years of community pharmacy dispensing data in Wales “at scale” has found no “immediate evidence of fraud”, according to results published by Audit Wales last month (May 23).
Audit Wales’ community pharmacy data matching pilot project examined a selection of dispensing data in two health boards covering “approximately 28%” of Wales’ community pharmacies, or more than 200 chemists, it said.
The national auditor worked alongside NHS Counter Fraud Service Wales to “provide insight to NHS Wales” about potential fraud, it added.
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It analysed three “markers of concern” - expensive items, specials and higher cost formulations - that had “known risks around fraud and cost”, Audit Wales said.
In total, its “interactive data tool” analysed 31 million lines of data between April 2018 and March 2021, it added.
While the analysis did not uncover fraud, it did reveal “fraud risks” and uncovered two “pricing errors” that caused overpayments to a sum of £22,000.
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Audit Wales noted that its analysis did not include “other ways” that fraud could take place, such as claiming for items that were dispensed but not collected.
But it said that it was able to identify “outlier” pharmacies, such as a contractor that dispensed a particularly large number of expensive items, which could then be looked at more closely.
“Known fraud risk”
In a letter presenting the findings to Wales’ chief pharmaceutical officer (CPhO) Andrew Evans, Wales auditor general Adrian Crompton said community pharmacy was selected for this exercise because the sector is “a known fraud risk” but is not “scrutinised for fraud as much as some other NHS services”.
Audit Wales added in its report that “more centrally supported work” to detect and prevent fraud in dispensing activity could prove “value for money” since health boards tend to analyse only their own data.
It said that the pilot project showed that it was “feasible to analyse entire populations of data”.
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But Crompton said that this pilot would not be expanded and Audit Wales would not “develop the tool further”, although there is “potential for others to adapt” the tool.
In July last year, a C+D investigation revealed that no fraud reports lodged against community pharmacy contractors had been converted into prosecutions by the NHS fraud office in over two years.
