Health Professional Compliance

Page last updated: 15 December 2016

Overview


Legislation
Medicare Benefits Schedule
Pharmaceutical Benefits Scheme
Dental schemes
Resources
Feedback

Overview

Compliance activities are focused on early intervention and prevention to help you get your correct entitlements, and assist you to meet your obligations and responsibilities. These activities target areas of inappropriate practice and fraudulent activity. Prosecution is considered where fraud is identified. We work with you to resolve any issues, if you have not complied with reporting requirements because of genuine mistakes.

Where we identify incorrectly claimed benefits, we will recover the money and you will have to repay amounts incorrectly received, regardless of how the incorrect payment occurred.

We work very closely with a wide range of stakeholders to ensure they are well informed on all aspects of our compliance approach.

We undertake education and compliance strategies to meet legislative requirements. The Human Services (Medicare) Act 1973 sets out the functions and powers to administer Medicare. It also defines the programs that fall under the Medicare service delivery brand.

Legislation

The legislation that governs the main health payment and services programs are the Medicare Benefits Schedule (MBS), the Pharmaceutical Benefits Scheme (PBS) and the Child Dental Benefits Schedule.

MBS

  • Health Insurance Act 1973
  • Dental Benefits Act 2008
  • Public Governance, Performance and Accountability Act 2013
  • Veteran’s Entitlement Act 1986
  • Health and Other Services (compensation) Act 1995
  • Privacy Act 1988
  • Privacy Amendment (Enhancing Privacy Protection) Act 2012
  • Aged Care Act 1997
  • Private Health Insurance Act 2007

PBS

  • National Health Act 1953
  • Drug and Poisons Act and Regulations applicable in the States and Territories
  • National Health (Pharmaceutical Benefits) Regulations 1960
The legislation that makes us accountable for the payments we administer under Medicare is the Public Governance, Performance and Accountability Act 2013.

CDBS

  • Dental Benefits Legislation Amendment Act 2014

Resources

Feedback

To provide feedback on health compliance, email Combined Compliance.