NHS England pilot new post payment verification system

1 June 2018

The Optical Confederation is working with NHS England and the NHS Business Services Authority (NHSBSA) to develop a new method of post payment verification (PPV) of GOS claims.

NHS England and the NHSBSA are piloting this new PPV method in Wessex, West Yorkshire and Harrogate, to gain a better understanding of the level of errors made in claims and provide assurance to NHS England that contractor claims are appropriate.

NHS England has a duty to ensure claims are checked, but the optical sector has had real concerns about the way in which previous PPV exercises have been carried out. The Optical Confederation has therefore worked closely with NHS England and the NHSBSA on the pilot, and will continue to do so, to ensure that the process is fair and equitable to all practices. 

NHS England’s interest in piloting the new process is partly driven by a recent unpublished report by the NHS Counter Fraud Authority, which suggested that the optical sector is at significant risk of both patient and contractor fraud. The Optical Confederation has challenged these findings and asked to see the evidence. We have not yet been shown the report, and therefore remain sceptical about its findings.


Notes to Editors

1. Due to resource issues, NHS England have not conducted PPV on a large scale in the optical sector, however they have a duty to ensure claims are checked.

2. The pilot areas that have been selected are Wessex, West Yorkshire and Harrogate. Practices taking part in the pilot in these areas will be selected using both a risk-based model and also a random selection. If the pilot is successful this process will be rolled out across England. 
3. NHSBSA have published information on the Post-payment verification of General Ophthalmic Services, including a: 
National Briefing - http://www.opticalconfederation.org.uk/downloads/guidance/ophthalmic-provider-assurance--national-briefing--31.05.18.pdf
Wessex Pilot Area Briefing - http://www.opticalconfederation.org.uk/downloads/guidance/ophthalmic-provider-assurance--wessex-area-briefing--31.05.18.pdf
West Yorkshire and Harrogate Pilot Area Briefing - http://www.opticalconfederation.org.uk/downloads/guidance/ophthalmic-provider-assurance--west-yorkshire-area-and-harrogate-briefing--31.05.18.pdf
4. NHSBSA will also publish further information on the scheme here: https://www.nhsbsa.nhs.uk/what-we-do/ophthalmic-provider-assurance