Service

Compliance & monitoring

As experts in claims and payment processing it comes as no surprise that AHA also has expertise undertaking monitoring and compliance programs to ensure appropriate expenditure of government funds.

Our monitoring and compliance team draws on sophisticated and rigorous data analysis and matching activities and associated audit and review activities to scrutinise claimants’ access to program funding.

Case study

Management of the Community Service Obligation Funding Pool

The purpose of the Community Service Obligation (CSO) Funding Pool is to ensure that all Australians have timely access to the PBS medicines they need, regardless of where they live.

The CSO Funding Pool makes it commercially viable for pharmaceutical wholesalers (CSO Distributors) to supply the full range of PBS medicines to pharmacies across Australia, regardless of pharmacy location and the relative cost of supply. Under these arrangements, payments totalling almost $200 million per annum are provided directly to Distributors who supply the full range of PBS medicines to any pharmacy within 24 to 72 hours, and who meet certain service standards.

A key component of our role in managing the CSO funding pool is monitoring the performance of CSO Distributors against the CSO Service Standards and Compliance Requirements. The CSO Service Standards and Compliance Requirements define the minimum services, standards and operating arrangements that CSO Distributors must meet to be eligible for payment. 

We monitor Distributors’ compliance with the service standards through desktop and site audits of Distributors, as follows:

  • The desktop audit of CSO supply data analyses monthly supply patterns by PBS product and pharmacy postcode. This information is compared by the system to previous monthly sales and outliers are identified for further review. This analysis is performed on approximately 2 million lines of confidential PBS medicine distribution data per month.

  • Site audits are conducted at approximately 16 CSO Distributor and subcontractor warehouses per year. This comprehensive audit program has driven improvements across the wholesale supply chain and ensured the level of service to community pharmacies remains high.

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ABN: 82 072 790 848 ACN: 072 790 848