Goodbye extrapolation?

Two recent National Health Service Litigation Authority (FHSAU) decisions look set to favourably adjust the balance of power between the new commissioners (NHS England) and dental contractors in relation to clawback demands resulting from alleged patterns of rogue claiming.

Many contractors have experienced the habit of some primary care trusts of picking out purported inappropriate claims in a sample. They identify them as a percentage of the sample and on the assumption that the sample is indicative of the total pattern of claiming, apply that percentage to the whole annual contract value often across successive years and demand huge sums be repaid.

Contractors have fought such claims, often successfully reducing the demand to a much smaller amount.

It has been possible to show that the sample of record cards, sometimes a relatively very small number, is not representative of the claims made in relation to the treatment of the whole patient base. This has sometimes been the case as a result of the way in which the PCT chose the sample in the first place, identifying cards where treatment has been provided and claims made on the basis of ‘outliers’, statistics which show certain patterns of claiming above or below the PCT or national average.