Services Australia has $1.5 billion in uncertified Pharmaceutical Benefits Scheme claims as of June 2024. The agency measures its own performance with metrics that count transferred calls twice. ANAO found the system only "partly effective" and made 7 recommendations, many of which were not acted on.
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$1.5B of Australian taxpayer money was wasted at Services Australia / Department of Health and Aged Care. Services Australia has $1.5 billion in uncertified Pharmaceutical Benefits Scheme claims as of June 2024. The agency measures its own performance with metrics that count transferred calls twice. ANAO found the system only "partly effective" and made 7 recommendations, many of which were not acted on.
Spread across Australia's 10.8 million households, that's roughly $139 per family — enough in total for funding roughly 13 public hospitals for a full year.
Services Australia has $1.5 billion in uncertified Pharmaceutical Benefits Scheme (PBS) claims as of June 2024.
Root cause: Services Australia and the Department of Health and Aged Care failed to reach bilateral service agreements defining processing standards and responsibilities. Without agreed standards, neither agency could be held accountable for the backlog.
Performance metrics manipulation:
- Services Australia counts completed "calls" differently than Health
- Phone calls transferred to another agency are counted as "completed" by Services Australia even though the work wasn't done
- This artificially inflates Services Australia's performance metrics
- Digital processing rejection rate (5.6%) is more than double the phone channel rate (2.3%) — ANAO noted this anomaly without explanation
ANAO made 7 recommendations in the PBS authority system audit. Services Australia's self-assessment of progress on recommendations was described by ANAO as "partly effective" at best.
Impact: $1.5B in pharmacy claims sitting unprocessed means pharmacists are carrying accounts receivable they can't collect, creating cash flow pressure across the pharmacy sector. Patients with complex medication needs face delays and potential gaps in supply.
Sources:
- Medical Republic: https://www.medicalrepublic.com.au/pbs-authority-system-an-unnecessary-brake-on-good-care/115225
- ANAO PBS audit: https://www.anao.gov.au/work/performance-audit/administration-of-the-pharmaceutical-benefits-scheme
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