Compliance for the Prescribed List

Our role

We work to ensure that medical device companies (sponsors), private hospitals and private health insurers comply with the Prescribed List Rules and legislation.

We prioritise action to tackle practices that:

• distort the benefit price settings
• encourage artificial listing structures
• create benchmark benefit pricing for discontinued or dormant devices (such as product substitution)
• support fraudulent listing
• lead to unfair listing arrangements (for example, applying for incorrect grouping)
• show repeated or wilful non-compliance (for example, providing false and misleading information during application)
• retain device listings on the Prescribed List for products that are no longer active on the Australian Register of Therapeutic Goods (ARTG)
• make false or misleading claims in application for listing
• reject legitimate benefit claims for devices listed on the Prescribed List
• process a benefit payment for less than the Prescribed List benefit.

Compliance strategy

Through a process of public consultation, we developed the Prescribed List Compliance Strategy.

The strategy applies to all stakeholders and identifies the principles that govern our compliance and enforcement functions and priorities.

Resources

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