Compliance to ramp up
September 4, 2013
The Federal Department of
Human Services has released
details of its “compliance program”
for 2013-2015, which includes a
range of activities to crack down on
fraudulent pharmacy claims.
“Most people are honest and
want to do the right thing...
however some people don’t fulfil
their obligations,” the DHS said.
The document details several
strategies, including “advanced
data analytical techniques to find
underlying patterns of incorrect
payment and fraud”.
This data analytics program
has extended beyond Medicare
providers to now include
pharmacies and consumers.
However “our focus is to educate
people and provide them with the
information they need to comply
and meet their obligations.
“We are committed to
reducing debt and establishing
early interventions to support
compliance,” the document states.
The department confirms that it
will continue to monitor payments
made under the Fifth Community
Pharmacy Agreement, with a
particular focus on Residential
Medication Management Reviews,
Home Medicine Reviews and
“payment processes for pharmacy
practice incentives”.
“We will also continue to monitor
approved suppliers making multiple
claims for the same supply of a
Pharmaceutical Benefits Scheme
prescription,” the document
adds, and where this results in an
overpayment “we recover incorrect
payments from the pharmacist”.
One example cited was a
pharmacist who admitted to
claiming the Medscheck incentive
without complying with the
requirements of the program,
which saw the department raise a
debt of more than $25,000 for the
incorrect claims.
The DHS says it also continues to
have concerns about high levels
of prescribing of medicines of
potential addiction, and will focus
on GPs who “inappropriately
prescribe addictive medicines”.
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