Fraudulent Prescription Form Reward Scheme

The Fraudulent Prescription Reward Scheme allows pharmacies to claim a financial reward where they have identified a fraudulent prescription form and thereby either prevented fraud or contributed with valuable information to the investigation of fraud. A reward is payable where:

• Fraudulent activity can be proven; and
• The conditions for the scheme are met.

Part XIVA of the Drug Tariff states:

‘The NHS Counter Fraud Authority (NHSCFA) (Referred to below as the Authority) is responsible for receiving and considering claims for reward payments in England.

The Scheme applies to all claims which are received by the Authority on or after 7 May 2003.

Retention and Reporting Reward: claims where a chemist –

(a) has not provided the drugs, medicines or listed appliances ordered on the fraudulent prescription form, or
(b) has provided the drugs, medicines or listed appliances ordered on the fraudulent prescription form, but had reason to believe at the time or subsequently came to have reason to believe that the form is fraudulent, and reports this to the relevant authorities.

The chemist will be eligible for a payment of £70.00, where all the conditions for either the retention element of the reward or the reporting element of the reward are met. Only one reward will be payable for each dispensing occasion.

The conditions for the retention element of the reward are:

• The drugs, medicines or listed appliances specified on the fraudulent prescription form have not been provided, the prescription form has been retained by the chemist, and the NHS Commissioning Board has been informed as soon as practicable, in accordance with Regulation 97(1)(a) of the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013;
• a claim is made by contacting the Authority as soon as practicable, normally within 7 days of the form having been presented. A claim form provided by the Authority must be completed and returned to the Authority, along with the original prescription form, normally within 28 days of the form having been presented; and
• the form presented as a prescription form was not a genuine order for the person named on the form. An order would not be a genuine order if, for example, it had been stolen or counterfeited and not signed by an authorised prescriber; or had been altered otherwise than by the authorised prescriber by whom it was issued.

The conditions for the reporting element of the reward are:

• The drugs, medicines or listed appliances specified on the fraudulent prescription form have been dispensed, but the chemist has reason to believe at the time or subsequently comes to have reason that the order is not genuine;
• the chemist has notified the NHS Commissioning Board as soon as practicable, in accordance with Regulation 97(1)(b) of the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013;
• a claim is made by contacting the Authority as soon as practicable, normally within 7 days of the form having been presented. A claim form provided by the Authority must be completed and returned to the Authority along with the original prescription form, normally within 28 days of the form having been presented;
• a detailed explanation of why the chemist felt it necessary to dispense must be included on the claim form. A reward will only be payable where the Authority is satisfied that the chemist had good and sufficient reasons to dispense; and
• the form presented as a prescription form was not a genuine order for the person named on the form. An order would not be a genuine order if, for example, it had been stolen or counterfeited and not signed by an authorised prescriber; or had been altered otherwise than by the authorised prescriber by whom it was issued.

Where the time-limits for either contacting the Authority and the NHS Commissioning Board or for returning a claim form to the Authority, as specified above, are exceeded, the Authority will nevertheless consider a claim if there are exceptional circumstances justifying the delay.’

Pharmacists who are eligible to claim a reward under the scheme should contact:

NHS Counter Fraud Authority
7th Floor
HM Government Hub
10 South Colonnade
Canary Wharf
London
E14 4PU
Tel: 0207 895 4545
Website: www.cfa.nhs.uk

Related Resources

Drug Tariff Resources

For more information on this topic please email ds.team@cpe.org.uk