BACKGROUND TO PROBITY CHECKS

The Health and Social Care Board has a responsibility to gain assurance that payments received by pharmaceutical contractors for provision of health services are fully justified and are made in accordance with the Northern Ireland Drug Tariff, the Pharmaceutical Services Regulations (Northern Ireland) 1997 and where appropriate the Northern Ireland Code Book.  Probity checks seek to gain verification that the services and prescriptions ordered are delivered correctly.

Undertaking payment verification does not imply a lack of trust in Community Pharmacies, it is a normal requirement to make available evidence of service provision to support financial reimbursement.

It is the current position that each pharmaceutical contractor should be monitored or subject to a verification exercise at least once every three years. However, this is the minimum requirement that is placed on the Health and Social Care Board (HSCB).  A review of available payment information held within the HSCB and the Business Services Organisation may prompt a review more frequently.

WHAT IS THE PROCESS?

Every quarter Probity Services carry out a review of payment information in respect of payments made to all pharmaceutical contractors.

On a quarterly basis Probity Services will select a number of pharmaceutical contractors for review.  The review will normally consist of one or more of the following:

  • Checking Clinics – where patients are invited to bring their current medication along to a local health facility where this is checked and verified against prescription details.
  • Desk Top Exercises – where a sample of prescriptions are selected from the monthly bundles and checked to provide assurance that the payment made in respect of each prescription is appropriate. The pharmaceutical contractor may be asked to provide further information in respect of this assurance work.*
  • Duplicate Reviews* – Each quarter 40 contractors are selected and sent a letter along with a spreadsheet detailing the duplicate prescriptions.  The letter asks the pharmacy to confirm if the items in the spreadsheet have been dispensed.  For items not dispensed Probity Services will seek recovery of the payment made.  Any governance concerns will be followed up by a HSCB Pharmacy Adviser.

*Whilst there are several means of verification open to Probity Services that do not require access to records held by the contractor, it may be necessary for Probity Services staff to access contractor records as part of the verification of claims (e.g. Minor Ailment Consultation Forms).  In undertaking these checks, Probity Services will be confirming that pharmacy records support information that they already have.

ADDITIONAL INFORMATION

Will pharmaceutical contractors be informed of the outcome of the checks?

Yes, contractors will normally be informed of the outcome of the Probity checks within a few weeks of the exercise taking place.

Are the above checks also carried out on Dispensing GPs and Appliance Contractors?

Yes, in addition to Community Pharmacies, the above contractors may also be selected as part of the post payment verification process.