As a major dental fraud is uncovered, ministers say system needs overhauling.
A review by NHS Protect said some dentists were claiming for work they had not done, or playing the system to get paid more than they should. The review, based on 5,000 bills, suggested about 3% of the 37.5m claims made each year were inappropriate - equivalent to £73m of payments. A new dental contract was introduced in 2006, which allows dentists to make claims for each course of treatment they deliver. Ministers said the current system was too open to abuse.
The investigation by the anti-fraud watchdog suggested some dentists had used the new system to spread treatment over many visits, allowing them to make multiple claims. Other inappropriate claims included bills for patients who did not exist, or for courses of treatment that real patients did not have. In total, as many as a million of the 37.5m claims made each year could be invalid, NHS Protect said.
Dermid McCausland, managing director of the watchdog, said, “NHS Protect will continue to ensure that public funds are not lost to a dishonest minority of dentists. Action will be taken against those who attempt to take valuable NHS resources for personal gain…As the lead organisation in tackling NHS fraud, NHS Protect will effectively coordinate investigative and intelligence resources and take swift action where suspicions of fraud are found. We will also seek the recovery of any NHS funds lost through the actions of fraudsters.”
The health minister Lord Howe said, “This shows the current dental contract system is not fit for purpose and needs to change to ensure NHS funds are protected and used to benefit patients. It is totally unacceptable that some NHS dentists have abused the system for personal gain. Fraud of any kind will not be tolerated and any allegation of fraud is taken seriously.” He went on, “We believe dentists should get paid for the quality of care they provide rather than simply for the number of treatments. That is why we are currently piloting this approach with dental practices ahead of the introduction of a new dental contract to make sure we get things right and minimise the risks of fraud.”
Pilots are already under way to test a new contract at 62 dental practices. They involve dentist pay being based on a combination of patient list size, quality of care and the number of courses of treatment. The aim is to give dentists more incentive to spend time with patients promoting good oral health, rather than just “drilling and filling” to meet treatment targets. If the pilots prove successful, the new system could be introduced in 2014.
John Milne, of the British Dental Association, said there may be good explanations for some of the seemingly inappropriate claims. But he added, “Where deliberate fraud occurs, it takes money away from patient care and is indefensible. The BDA fully supports the counter-fraud activities undertaken by the NHS to detect and eradicate any such activity.”
The Department of Health said the NHS was taking action against the dentists exposed by the research.