A data matching pilot for community pharmacies in Wales has revealed some risks but no immediate evidence of fraud, according to the country’s central auditor.
Audit Wales has published the findings of the pilot, which involved analysing dispensing data to provide insights for NHS Wales on areas of high cost and fraud among community pharmacies.
It was also intended to help Audit Wales develop its expertise in fraud analytics techniques. Community pharmacies were chosen as the focus as they had been identified as an area of fraud risk and are not subject to the same scrutiny as other NHS services.
The work involved the use of an interactive data tool based on Microsoft Power BI that made it possible to explore the data quickly and identify points of concern. It flagged up outliers and formed the basis of discussions with health boards.
Analysis was focused on three known areas of risk: higher cost formulations of medicines; expensive items, with a net ingredient cost of £100 or more; and ‘specials’, which require special preparation by a registered manufacturer.
Outliers and overpayments
Audit Wales said that will it did not find immediate evidence of fraud it did identify outliers with overpayments totaling £22,000, which is now being recovered, and estimated that over the three years covered by the pilot the costs of specials could have been reduced by approximately £700,000.
“We will build upon the learning from the pilot and look to undertake new fraud analytic projects, including one using a data matching approach to explore whether patients are accurately registered in GP lists,” it added.
The organisation collaborated on the project with the NHS Counter Fraud Service Wales.
