LEGISLATION designed to cut healthcare fraud is being welcomed by the Pharmacy Guild of Australia.
The Health Legislation Amendment (Data-Matching) Bill 2019, put before the Commonwealth Senate on Mon, will allow the Commonwealth to data-match across the Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) for Medicare compliance.
Guild Victorian Branch President, Anthony Tassone, welcomed the legislation.
"Our members often raise concerns over compliance matters, such as unapproved pharmacies claiming pharmaceutical benefits and pharmacies failing to raise the co-payment with their patient," he said.
"If there is any way to use the data-matching in the proposed legislation to enhance the Department's detection capabilities of these particular practices then the Guild believes it should be permitted.
"While the proposed Bill does not necessarily address these particular concerns, the Guild acknowledges that improving the Department's data-matching abilities is a positive step toward reducing fraudulent activities.
"The Guild understands that the intention of the proposed Bill is specifically to reduce intentionally fraudulent activity but recognises the potential to also identify instances where health benefits have unintentionally been claimed incorrectly. Typically in these cases the supply of the health benefit to the patient is appropriate, but due to a technical anomaly in the prescribing or dispensing process, the claim is not accepted.
"For a PBS claim, this can result in the pharmacy being financially penalised for a technical anomaly, and given the increasing incidence of high-cost medicines being listed on the PBS, the financial risk to pharmacists can be significant."
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