Ensuring The Integrity Of Medicare: Increased MBS Compliance Audits

The Australian Government is boosting the Medicare compliance program by increasing audits on Medicare Benefits Schedule services – saving taxpayers money and reducing the incidence of incorrect billing of Medicare services.

Page last updated: 13 May 2008

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13 May 2008

The Commonwealth Government is moving to further protect the integrity of Medicare by boosting the Medicare compliance program.

The Government is increasing audits on Medicare Benefits Schedule (MBS) services to ensure that doctors are fulfilling the requirements of relevant MBS item descriptors.

Minister for Health and Ageing, Nicola Roxon said, “This will save taxpayers money, and reduce the incidence of incorrect billing of Medicare services.”

Medicare Australia will impose sanctions on practitioners who are billing inappropriately, but whose practice does not warrant referral to the Professional Services Review (PSR) or for criminal investigation.

At the same time, the Government is increasing the powers of Medicare Australia to compel doctors to produce evidence when asked to substantiate their Medicare billing. At present, practitioners are not required to produce documents to substantiate their billing practices if the evidence is contained in a patient record.

Minister for Human Services, Joe Ludwig said: “The measure will benefit all Australians by ensuring that Medicare providers are billing the correct benefit for the service provided to a patient.”

“Doctors found to be billing items inappropriately will receive education on how to bill the relevant MBS items correctly.”

Under the measure, Medicare Australia will undertake an additional 2,000 audits each year on practitioners who provide Medicare-eligible services. This increases the audit coverage from 0.7 per cent to 4 per cent of practitioners who provide Medicare services.

The Department of Health and Ageing, in conjunction with Medicare Australia, will undertake significant consultation with the medical profession and other stakeholders about the changes. The Privacy Commissioner is being consulted in the development of the initiative. Increased auditing will start from 1 January 2009.

Media inquiries only: Sean Kelly – 0417 108 362
For all other inquiries please contact the Minister's office – 02 6277 7220