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DH rejects ‘highly speculative’ estimate of general practice fraud

The Department of Health has said it does not recognise the ‘highly speculative’ figures in a report on NHS fraud, which claimed that GPs were likely to be responsible for £348m in falsely claimed costs.

The estimates from the ‘Financial cost of healthcare fraud 2015: What data from around the world shows’ report by PFK Littlejohn LLP accountants were widely reported in the national press – but the report itself describes the figures as ‘best estimates’.

Led by the former CEO of the NHS Counter Fraud Service, Jim Gee, who is now director of counter-fraud services at PKF Littlejohn, the report acknowledges that ‘there has never been a successful NHS loss measurement exercise looking at expenditure on general practice’.

It instead uses a ‘healthcare global average fraud loss rate’ of 4.57% to extrapolate the cost of fraud from the total NHS expenditure on general practice – £7.63bn.

And it runs this estimate alongside a single case study of a GP who falsified patient records to steal £62,00.

It states other types of fraud in general practice include ‘claiming for enhanced services that weren’t provided’, ’false prescriptions for self-medicating’ and even ‘accepting bribes to register overseas visitors’.

The report does not give any details to support the latter examples and a Department of Health spokesperson said: ‘We do not recognise the figures in this highly speculative report, which is full of inconsistencies. We are determined to stamp out fraud in the NHS through better information sharing to prevent and deter fraud, and we are working with NHS Protect on crime risks and trends to do even more in the future.’