NHS fraud could be as high as £5bn a year

London: Fraud may be costing the UK’s National Health Service £5 billion (Dh30.28 billion) a year, more than 20 times the government’s official figures, with at least another £1 billion being lost due to financial errors, according to a former senior official responsible for tackling the crime.

Jim Gee said the health service loses 7 per cent of its budget annually to fraud and mistakes, amounting to about £7 billion, and most of that was down to crime. Official statistics, which show £229 million of losses through patients and dentists making false financial claims, are ‘completely implausible’, he said. The government disputes Gee’s estimates.

He told the BBC’s Panorama programme, due to be screened on Monday night, that if the NHS was losing only this amount “it would be doing 30 times better than any other healthcare organisation in the world”.

Government figures ignored losses that might be taking place in payroll and procurement, areas where there was ‘great potential for fraud’, according to Gee. He is the former director of NHS counter-fraud services and now chairs the advisory board of Portsmouth University’s centre for fraud studies and is an author of the centre’s report on the issue to be published this week.

Panorama says its own freedom of information requests reveal that there are more than 300 fraud investigators in NHS Protect, the body responsible for tackling economic crime against the service in England and Wales. The Department of Work and Pensions employs six times that number to combat benefit cheats, the programme says.

Gee said the NHS staff wanted to do more but did not have the resources to do the job. “Cutting the budget of NHS Protect sends a message to fraudsters that there will be greater opportunities for them to gather their ill-gotten gains.”

Panorama will give examples of individual frauds, including stolen medical products being sold on eBay, a doctor using patient records to obtain prescriptions for drug addiction and dentists charging for unnecessary procedures or work they have not done.

The Department of Health told Panorama in a statement it “did not recognise” Gee’s figures, and added on Sunday night: “Fraud against the NHS is a crime that can have a serious impact on our ability to deliver high quality health services. Any allegation or suspicion of fraud should be referred to NHS Protect, who are required to take appropriate action. When fraud is proven, we expect all appropriate sanctions and recovery action to take place.”

Andrew Gwynne, shadow health minister, said ministers must explain why the NHS was ‘haemorrhaging’ the amounts suggested by Gee. “After David Cameron’s costly reorganisation, it can ill afford further ministerial incompetence. Patients are already paying the price.

“The government must account to parliament for this scandalous abuse of precious NHS resources and explain how it will put an end to it.”

The £229 million figure comes from the government’s Annual Fraud Indicator, which only offers two specific areas of NHS fraud, £156 million for patients falsely claiming exemption from charges, including for prescriptions, and £73 million for dentists making false claims. It says, however, there may be £2.3 billion worth of procurement fraud affecting the UK public sector and £335 million in payroll fraud in England, Scotland and Wales.

Last week, a Rochdale doctor who stole more than £62,000 from the NHS was sentenced to nine months in prison, suspended for 18 months, and ordered to pay £50,000 costs. Thirumurugan Sundaresan admitted falsifying the records of 1,703 patients to hit targets and increase payments from the NHS to his practice.

Earlier this month, Joyce Trail, a Birmingham dentist jailed for seven years in 2012 for stealing £1.4 million from the NHS, was issued with court orders that should see substantial sums given back to the health service. The NHS is also taking steps to cancel her pension.