Northern Ireland could be losing millions of pounds a year through fraud in primary care, a report from the Northern Ireland Audit Office has concluded.
The report, issued last week, expresses concern about the 'volume of claims' submitted for payment by family practitioners and the 'relative weakness' of systems for detecting fraud.
It says payments to family practitioners totalled 131m in 1996-97, and the 'sheer volume' presents 'an inherent risk to good control'.
The report by NIAO head John Dowdall quotes from an internal audit of the Northern Ireland Central Services Agency. It found that payment systems 'remain constantly open to abuse by dishonest practitioners and members of the public' and the potential for fraud by practitioners is 'unlimited'.
More than 20 million prescription items were dispensed in Northern Ireland last year, an average of 12 per person. Just 7m was collected in charges because 95 per cent of recipients claim exemptions. The NICSA checks the validity of a 'small but statistically based' sample of these exemptions and estimates the potential loss through non-payment of prescription charges at 3.9m.
The NIAO report says this 'underestimates abuse'. It argues that if all non-validated claims in the sample are 'invalid exemptions', losses could be as high as 15.1m.
The Department of Health and Social Services said this assumption was 'unsafe'.
The NIAO says is was notified of just 11 cases of fraud last year involving primary care. It recommends that all cases should be given 'the widest possible publicity' to have a deterrent effect.
Controls to Prevent and Detect Fraud in Family Practitioner Service Payments. Report by the comptroller and auditor general for Northern Ireland.
Stationery Office. 10.85.