Prescription fraud – combined with bribery and corruption – costs NHS England an estimated £1.21 billion per year (based on FY 2019-20). This is in the context of a £140 billion yearly budget in the same period, culminating in almost 2% of budget lost due to illegal activity.
In 2018 the NHS Counter Fraud Authority (NHSCFA) set out a five-year plan aimed at combating this, and in 2020 the Department for Health and Social Care (DHSC) shared their three-year counter fraud strategy. Both agencies are focused on reducing illegal activities which lead to these eye-watering figures. So, with that in mind, how can private and NHS contracted healthcare organisations take steps to create robust anti-fraud processes and procedures within their own operations?
One of the most common weak points in the fraud floodgate can stem from limited adoption of fully integrated digitisation within the healthcare ecosystem. Take for example, the standard patient experience.
It is a simple, but also cumbersome, experience and there are several stages at which fraud can take place. This is not necessarily due to the simplicity of the experience, but the fact that a physical script with a wet signature is vulnerable to various forms of fraudulent and counterfeit activities.
The standard prescription process has remained so for around 300 years – pen & paper are used to issue, authorise, and dispense prescription medications. They act like a letter of reference for the patient to the pharmacist, with the issuing doctor acting as guarantor. However, pen & paper prescriptions are at considerable risk of fraud. It can be easy to make copies that are difficult for any individual pharmacist to spot.
There are numerous case studies demonstrating how easy this process is, and of course, the figures speak for themselves.
There are examples of pharmacists using Tippex to change prescriptions, patients wrongly claiming cost exemptions, carers accessing medications under the guise of looking after a relative, GPs forging prescriptions using real patient details, or people using the ID of deceased friends to access medications. One thing these all have in common is that the physical paper prescription was easily altered, and the very nature of a disjointed and hard to track paper system meant bad behaviour could go unnoticed for prolonged periods of time.
There is no blame attributed to any one group, but the issue lies with the antiquated prescription process which provides opportunity for individuals with bad motives to act illegally.
Over the previous two decades we have seen transformative digital adoption across many mammoth sectors of the economy, such as financial services, consumer retail, and FMCG. The health and wellness sector has kept pace - in some areas - however there is a clear disconnect in the end-to-end patient-clinician experience when it comes to pharmacy provision.
The robust, auditable, and efficient digital experience cuts off, and in steps the stalwart pen & paper prescribing process. However, bridging this digital gap can have a hugely positive impact on the opportunity to commit fraud and engage in illegal behaviour. There are promising signs of early digital impact, with the NHS Electronic Prescription Service in place and plans to expand its use in NHS settings.
We did not build it to stop fraud. We built it because healthcare should be easy for every stakeholder in the ecosystem to manage. And it should be secure. Our revolutionary Phlo Connect solution means everything is tracked, logged, backed-up, and fully auditable. It means patterns of behaviour and trends in prescribing can be monitored automatically; allowing for early detection of unscrupulous behaviour.
We believe that the adoption of secure digital prescribing technology, which can be seamlessly integrated into existing healthcare systems, mitigates the initial risk, and enables early detection of fraudulent behaviour.
Read more about why we built Phlo Connect and how it is transforming the way we view and accept the traditional pharmacy experience. We are trusted by leading global healthcare providers to deliver ground-breaking secure digital transformation that enhances clinician and patient healthcare experiences.
Contact us to discover more about Phlo Connect and how we can work together to create anti-fraud centred digital experiences for your clinicians and patients. Partner with Phlo Connect today.