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News - May 2012

Dental fraud costs £70 million over year

30 May 2012

DENTAL fraud cost the NHS in England over £70 million in the year 2009-10, according to figures published by the government agency NHS Protect.

The report looked at the prevalence of suspected fraud in contractor claims within NHS dental services based upon a random sample of 5,000 FP17 dental activity reports for completed treatments drawn by NHS Dental services. This was the first such exercise undertaken since the current dental contract was introduced in April 2006.

The report concludes that there was an estimated loss due to suspected contractor fraud of £73.19 million during 2009‐10 based upon an assessment of resolved treatment queries, with a potential for a further £5.31 million of loss in unresolved queries. It is estimated that during this period almost one million inappropriate claims (FP17s) were submitted for payment.

The types of suspected contractor fraud included patients not receiving the level of treatment on the FP17 (50 per cent), split courses of treatment (27 per cent), patients not visiting the dentist (12 per cent), fictitious patients (10 per cent) and patients paying for treatment but marked as exempt on the FP17 (1 per cernt).

The report estimates that without some form of intervention a further £146.38 million could be lost to fraud before the new dental contract is in place in April 2014.

But the British Dental Association has urged caution in the interpreting the results. Dr John Milne, chair of the BDA's General Dental Practice Committee, said: "These figures will need to be looked at carefully and understood to ensure that the cases of fraud are distinguished from cases where a course of treatment has been staged for legitimate reasons. It cannot be assumed that treatment that has been planned in a phased way, or had to be restarted during what was intended to be a single course, is fraudulent; that simply isn't the case. There are clinical factors that can explain both scenarios.

"A number of issues have arisen with the workings of NHS dentistry since the introduction of flawed contractual arrangements in 2006. Those arrangements have proved unpopular with patients and dentists alike. A new contract is now being piloted. The BDA supports this development, which it hopes will address the many problems the current contract has created."