Audit and compliance activities on the way

health professional at computer with magnifying glass

The Pharmacy Programs Administrator has stated that from 1 February 2020, it will commence ongoing active monitoring and compliance activities

In a statement on Thursday the PPA noted that it is authorised, under its contract with the Department of Health, to undertake monitoring and compliance activities in relation to programs funded under the Sixth Community Pharmacy Agreement.

These activities inform and support audit activity undertaken by the Department and assist the Department and PPA to maintain compliance with the Public Governance, Performance and Accountability Act 2013 (Cth), it says.

“From 1 February 2020 the PPA will commence active monitoring and compliance activities and these activities will be ongoing,” the Administrator said.

“These activities include approaches and mechanisms to prevent, detect, investigate and correct claims which are inaccurate, inappropriate or are not in accordance with the relevant Program Rules (i.e. are ineligible).”

It warned that in circumstances where inaccurate, unsubstantiated or ineligible claims are identified, it may refer the service provider and all evidence to Health for consideration.

“Corrective actions to be taken will be based upon a range of factors, including but not limited to the nature, scale and value of any inaccurate/inappropriate claiming activity as well as whether the identified issue is a first, or repeat occurrence,” the PPA said.

A range of corrective actions may be pursued, including but not limited to one or more of the following:

  • issue an official caution or warning;
  • implementation of enhanced monitoring activities in relation to the Service Provider;
  • require the repayment of all or part of the inaccurate or unsubstantiated claims;
  • suspend or cancel the Service Providers’ registration for one, multiple or all Programs;
  • review of all government funds provided to the Service Provider (e.g. PBS);
  • referral of pharmacist(s) to AHPRA for investigation;
  • referral to law enforcement agencies, as appropriate; and/or
  • any other action provided for under the National Health Act 1953 (Cth).

The PPA recommended that pharmacies take this opportunity to review their service and claiming arrangements.

These arrangements need to ensure compliance with the Program Rules and General Terms and Conditions as written and published on the PPA website.

Pharmacies also need to ensure that appropriate documentation (such as signed patient consent forms) is maintained in relation to each service or claim.

The PPA notes that the Program Rules and General Terms and Conditions provide for this monitoring, compliance and audit approach; it also directs pharmacists to its website for more information.

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