Dentists claiming for work not carried out
Dental fraud cost the NHS over £70m in one year alone, reveals a report published this week.
A report published by NHS Protect, the body responsible for tackling and identifying crime across the health service in England, found that dentists are claiming for treatment that was never carried out.
NHS Protect estimates that in a 12-month period between 2009 and 2010, almost one million inappropriate claims were submitted for payment at a cost of £73.2m to the NHS.
It said that with revised contract arrangements not expected until April 2014, a further £146.4m could be lost to fraud while the existing dental contract remains in place.
The current dental contract, introduced in 2006, allows patient treatment to fall into specific charging bands whereby patients pay only one fee for their entire course of treatment, as opposed to individual fees per item of treatment received, as under the old system.
It also allows dentists to earn Units of Dental Activity (UDAs) for every course of treatment provided, which contribute towards the total quantity of UDAs they must provide according to their service contract, as agreed with their local Primary Care Trust.
Of the suspected fraud identified, 50% of cases were for patients receiving a different level of treatment to that specified, while 27% of cases were for dentists splitting up single courses of treatment into separate claims in order to earn more UDAs.
A further 12% of cases were for patients who did not visit the dentist, while in 10% of cases the patient did not exist and in 1% of cases the patient paid for treatment but was marked as exempt.
Health minister Lord Howe said: “This shows the current dental contract system is not fit for purpose and needs to change to ensure NHS funds are protected and used to benefit patients.
“It is totally unacceptable that some NHS dentists have abused the system for personal gain. Fraud of any kind will not be tolerated and any allegation of fraud is taken seriously.”
He added: “We believe dentists should get paid for the quality of care they provide rather than simply for the number of treatments. That is why we are currently piloting this approach with dental practices ahead of the introduction of a new dental contract to make sure we get things right and minimise the risks of fraud.”
Dermid McCausland, managing director of NHS Protect, said: “NHS Protect will continue to ensure that public funds are not lost to a dishonest minority of dentists. Action will be taken against those who attempt to take valuable NHS resources for personal gain.”