Date: 16 July 2019
A number of pharmacies have recently received a letter from the Department of Health Compliance Operations Branch regarding PBS multiple payments. This letter is the result of an ongoing review of PBS Online claiming by approved pharmacies, specifically targeting instances where multiple claims may have occurred for the same PBS item.
As this review is not an audit, the pharmacists who have received letters in this mail out are not required to send any response to the Department. If they have checked the relevant claims and are satisfied that the highlighted claims have not been made for multiple payments, then they are not required to do anything more. If this is the case, a pharmacist may still email the Voluntary.Compliance.Team@health.gov.au with their reference number, simply acknowledging that they have reviewed their claims as outlined in the schedule they received and believe they are compliant. This will be recorded against their reference number.
If a pharmacist has reviewed their claims and has identified that the claims are not correct, then the approved pharmacist should complete the voluntary acknowledgement form sent with the letter. If the pharmacist has a specific query relating to prescriptions that have been flagged for review and would like further advice before completing the voluntary acknowledgement form, then they should email the Compliance Team.
Currently it is taking 5-10 working days for the Compliance Team to respond to emails. They are working through each email in the order that it has been received and guarantee that they will respond to all correspondence. They have requested that pharmacies do not send multiple emails as this will slow the process down. Pharmacists emailing the compliance team should include details such as:
The Department has advised the Guild that there will be an extension to the deadline of 15 February 2019 stated in the letter. The deadline has now been extended to 1 March 2019. This will not be communicated by the Department, however their information will be updated to reflect this new deadline and communicated in individual queries sent by pharmacists to this team.
It is an approved pharmacy’s responsibility to ensure that they dispense and supply pharmaceutical benefits in accordance with the relevant legislation, and an approved pharmacist must not supply a pharmaceutical benefit to a person unless the prescription is written in accordance with the legislation. The National Health Act 1953 and National Health (Pharmaceutical Benefits) Regulations 2017 underpins the framework that governs the PBS, specifying the conditions for prescribing, supply and payment for the supply, of pharmaceutical benefits. If two prescriptions are written on the same day for the same item for the same patient, one is a valid PBS prescription and the other may only be supplied as a private item to a patient.
While this current compliance exercise is entirely voluntary, the department will continue to monitor PBS claims into the future and may take compliance action, such as an audit, if concerns are identified that an approved supplier has not met the PBS requirements and has been paid pharmaceutical benefit payments they were not entitled to receive. If this occurs, administrative penalties may be applied and debt recovery action will be taken
Contact: [Squiz] Ivan Xue