To ask the Scottish Executive how many false (a) payment claims have been made by dental practitioners in the NHS and (b) claims of exemption from dental charges have been made by patients in each year since 1999, broken down by NHS board area and detailing the amounts in each case.
The Executive have supplied the following corrected answer:
Mr Tom McCabe: The information requested is in the tables below.
Recovery Values of Claims Made by Dentists Under General Dental Services and Identified by Post Payment Procedures as False or Erroneous1
NHS Board | Financial Year 1999-2004 | Total Recovery (£) |
1999 (£) | 2000 (£) | 2001 (£) | 2002 (£) | 2003 (£) | 2004 (£) |
Argyll and Clyde | 0.0 | 9,579.75 | 11.00 | 13,640.14 | 292.86 | 1,385.10 | 24,908.85 |
Ayrshire and Arran | 72,035.40 | 9,331.15 | 192.87 | 61.80 | 243.14 | 1,239.96 | 83,104.32 |
Borders | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 935.49 | 935.49 |
Dumfries and Galloway | 0.00 | 381.20 | 2,029.95 | 0.00 | 0.00 | 453.43 | 2,864,58 |
Fife | 0.00 | 843.04 | 0.00 | 0.00 | 351.25 | 1,471.71 | 2,666.00 |
Forth Valley | 444.85 | 0.00 | 1,500.00 | 319.20 | 1,405.25 | 802.36 | 4,471.66 |
Grampian | 0.00 | 68.20 | 7,931.69 | 6,504.98 | 389.22 | 410.91 | 15,305.00 |
Greater Glasgow | 366.96 | 9,776.92 | 1,140.07 | 1,004.97 | 14,586.62 | 17,862.12 | 44,737.66 |
Highland | 0.00 | 734.72 | 20.34 | 167.25 | 224.90 | 8,257.06 | 9,404.27 |
Lanarkshire | 0.00 | 0.00 | 35.80 | 0.00 | 2,943,19 | 1,616.78 | 4,595.77 |
Lothian | 2,155.95 | 99,316.68 | 47.05 | 227.02 | 471.10 | 10,359.09 | 112,576.89 |
Orkney | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 5.60 | 5.60 |
Tayside | 0.00 | 596.81 | 14,850.72 | 8,932.25 | 8,674.95 | 2,115.33 | 35,170.06 |
Western Isles | 0.00 | 0.00 | 0.00 | 0.00 | 2.66 | 0.00 | 2.66 |
Total for Year Ends | 75,003.16 | 130,628.47 | 27,759.49 | 30,857.61 | 29,585.14 | 46,914.94 | 340,748.81 |
Note:
1. Where the recovery period extends over two or more years, the total amount is only allocated to year 1.
Total Value of Claims Made by Dentists Under General Dental Services and Identified By Systems at Pre-Payment Stage as False or Erroneous1,2,3
NHS Board | Calendar Year 1999-2004 | Total |
1999 (£) | 2000 (£) | 2001 (£) | 2002 (£) | 2003 (£) | 2004 (£) |
Argyll and Clyde | 54,969.00 | 71,395.00 | 58,815.00 | 49,164.00 | 45,063.00 | 8,439.00 | 287,845.00 |
Ayrshire and Arran | 41,945.00 | 56,082.00 | 45,219.00 | 39,988.00 | 35,609.00 | 6,157.00 | 225,000.00 |
Borders | 14,452.00 | 19,245.00 | 16,270.00 | 15,281.00 | 11,281.00 | 1,931.00 | 78,460.00 |
Dumfries and Galloway | 16,194.00 | 22,022.00 | 13,205.00 | 12,349.00 | 11,329.00 | 1,539.00 | 76,638.00 |
Fife | 47,981.00 | 62,212.00 | 49,214.00 | 46,117.00 | 38,476.00 | 6,311.00 | 250,311.00 |
Forth Valley | 40,479.00 | 52,323.00 | 45,071.00 | 40,201.00 | 38,153.00 | 7,170.00 | 223,397.00 |
Grampian | 69,318.00 | 86,152.00 | 62,955.00 | 52,394.00 | 41,228.00 | 7,299.00 | 319,346.00 |
Greater Glasgow | 142,234.00 | 185,541.00 | 150,034.00 | 140,537.00 | 126,690.00 | 23,157.00 | 768,193.00 |
Highland | 22,876.00 | 28,428.00 | 23,145.00 | 22,801.00 | 18,485.00 | 3,503.00 | 119,238.00 |
Lanarkshire | 68,387.00 | 88,040.00 | 75,750.00 | 70,854.00 | 67,865.00 | 11,768.00 | 382,664.00 |
Lothian | 111,821.00 | 150,361.00 | 130,861.00 | 126,569.00 | 112,277.00 | 19,213.00 | 651,102.00 |
Orkney | 2,093.00 | 2,910.00 | 2,401.00 | 1,769.00 | 1,799.00 | 257.00 | 11,299.00 |
Shetland | 2,368.00 | 3,343.00 | 2,787.00 | 4,463.00 | 4,566.00 | 577.00 | 18,104.00 |
Tayside | 56,724.00 | 78,769.00 | 66,112.00 | 54,965.00 | 43,733.00 | 7,377.00 | 307,671.00 |
Western Isles | 3,852.00 | 4,749.00 | 3,490.00 | 2,140.00 | 2,443.00 | 280.00 | 16,954.00 |
Grand Total | 695,693.00 | 911,572.00 | 745,329.00 | 679,583.00 | 598,997.00 | 104,978.00 | 3,736,152.00 |
Notes:
1. These figures may differfrom other published figures as they are specifically targeted to show false orerroneous rather than incomplete claims.
2. These figures representthe difference between the amount claimed and the amount authorised.
3. A number of these claimsmay subsequently be corrected and re-submitted.
4. The figures for 2004 relate to January to March only.
Investigations by NHSScotlandCounter Fraud Services Into Potentially False Claims by Dentists Under GeneralDental Services 2001-04
Year | Number of Investigations Commenced | Number of False Claims Identified | Total Potential Value to NHSScotland |
2001 | 2 | 31 | £2,796 |
20021 | 1 | 68 | £173 |
2003 | 2 | 1 Pro-active investigation2 1 investigation where no decision has been made as to whether there is a case to investigate | £400,000 |
2004 | 1 | No decision has been made as yet on whether there is a case to investigate | - |
Notes:
1. Although the monetaryvalue of this case is small, it raises clinical governance issues.
2. In 2003 apro-active exercise was carried out on gold restorations. The potential forfalse claims involving gold restorations equates to in excess of £400,000. ABulletin was sent to all dentists on NHS board lists highlighting the problem.The impact of the bulletin is being measured currently to determine if thenumber of claims has decreased.
Number of Patient ExemptionClaims Checked by NHSScotland Counter Fraud Services 2000-011 and2001-022
Year | Number of Cases Checked | Number of Cases Confirmed as Exempt | Number of Cases Where The Patient Has Paid The Statutory Charge or the Penalty Charge | Amount Recovered |
2000-01 | 0 | 0 | 0 | 0 |
2001-02 | 5,240 | 3,394 | 231 | £9,354 |
Notes:
1.No dental claims were checked in 2000-01 since the wording of the patientdeclaration on payment claim forms did not allow NHSScotland Counter FraudServices to confirm patient data with other relevant bodies under the DataProtection Act 1998. The wording was amended subsequently.
2.The manual checking system in use enabled reports to be provided only on aScotland-wide basis.
Numberof Patient Exemption Claims Checked by NHSScotland Counter Fraud Services2002-031
NHS Board | Number of Cases Where a Decision has been made as to eligibility | Number of Cases Where The Patient Has Paid The Statutory Charge or the Penalty Charge | Amount Recovered |
Ayrshire and Arran | 178 | 22 | £773.18 |
Borders | 85 | 5 | £222.70 |
Dumfries and Galloway | 98 | 7 | £163.96 |
Fife | 198 | 12 | £312.68 |
Forth Valley | 138 | 10 | £233.24 |
Grampian | 177 | 13 | £294.62 |
Greater Glasgow | 339 | 33 | £1,359.00 |
Highland | 92 | 4 | £109.24 |
Lanarkshire | 189 | 17 | £957.40 |
Lothian | 267 | 30 | £863.88 |
Orkney | 4 | 1 | £4.00 |
Argyll and Clyde | 141 | 19 | £1,132.22 |
Shetland | 15 | 0 | £0.00 |
Tayside | 140 | 11 | £472.44 |
West Lothian | 0 | 0 | £0.00 |
Western Isles | 1 | 0 | £0.00 |
Totals | 2,062 | 184 | £6,898.56 |
Note:
1.An automated patient exemption checking system (PECS) developed in 2002003 hasenabled reports to be produced at NHS Board level in a different format.
Numberof Patient Exemption Claims Checked by NHSScotland Counter Fraud Services 2003-041
NHS Board | Number of Cases Where a Decision has Been Made as to Eligibility | Number of Cases Where The Patient has Paid the Statutory Charge or the Penalty Charge | Amount Recovered |
Ayrshire and Arran | 402 | 33 | £1,654.42 |
Borders | 132 | 10 | £308.86 |
Dumfries and Galloway | 187 | 21 | £861.52 |
Fife | 400 | 38 | £1,115.47 |
Forth Valley | 291 | 21 | £1,197.48 |
Grampian | 652 | 46 | £1,730.46 |
Greater Glasgow | 997 | 114 | £6,094.23 |
Highland | 245 | 30 | £1,119.38 |
Lanarkshire | 599 | 59 | £2,535.88 |
Lothian | 832 | 104 | £5,005.26 |
Orkney | 61 | 2 | £19.72 |
Argyll and Clyde | 295 | 44 | £1,601.75 |
Shetland | 49 | 1 | £97.12 |
Tayside | 421 | 39 | £1,890.58 |
West Lothian | 0 | 0 | £0.00 |
Western Isles | 54 | 4 | £99.88 |
Totals | 5,617 | 566 | £25,332.01 |
Note:
1.An automated patient exemption checking system developed in 2002-03 has enabledreports to be produced at NHS board level in a different format.
NHSScotland Counter FraudServices have recently completed the first stage of a risk measurementexercise, based on a statistically robust sample of claims paid in February2003, to establish the level of patient fraud and error in Scotland inclaiming exemption from charges in NHS family health services. As a result, thepatient exemption fraud/error level in general dental services is estimated at7.63% with an error margin of plus or minus 1.69%. A second risk measurementexercise will be undertaken in 2005.