Improved Medicare compliance

Posted 5 years ago

On 1 July 2018, the Australian Government introduced several legislative changes aimed to improve Medicare Compliance, through the Health Legislation Amendment (Improved Medicare Compliance and Other Measures) Act 2018.

The key changes for health professionals are:

  • A new requirement to keep records for a minimum of two years including referrals and documents created as a condition of claiming an Medicare Benefits Schedule (MBS) item
  • The Department of Health can issue a Notice to Produce as part of a compliance activity, which requires you to produce documents relating to items claimed. Before issuing the Notice, the department must first provide an opportunity for you to respond to compliance concerns and provide substantiation of claims
  • Financial Administrative Penalties can be applied to a debt of more than $2,500 if substantiating documents are not provided, or not provided within the required timeframe
  • Improved debt recovery mechanisms that allow the department to offset or deduct a debt owed from amounts payable to the debtor or to garnishee debts from a debtor’s bank account
  • From 1 July 2019, the Shared Debt Recovery Scheme will commence and will allow the Department to hold an employing organisation responsible for a portion of debts incurred as a result of incorrect Medicare claiming. The one year delay in the Scheme’s introduction allows for consultation with peak bodies to generate Regulations under which the Scheme will operate
  • To assist in this, information about a health professional’s employer or contracting organisation will now be required when applying for a provider number.

For more information, please view this Factsheet, visit the Department of Health website or email the department.