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Formal notice to produce documentsUnder section 129AAD of the Health Insurance Act 1973, if we have reasonable concern that you've been paid a benefit that exceeds the amount you should have been paid, we can ask you to substantiate your claims.
A formal notice to produce documents will be issued if you don't provide substantiating documents for Medicare compliance audit or review purposes.
Obligations under the under the Public Governance, Performance and Accountability Act 2013Under the Public Governance, Performance and Accountability Act 2013, we must recover money owed to the Australian Government. If you incorrectly claim a Medicare benefit or receive an incorrect payment, you’ll be asked torepay the money you received.
Voluntary acknowledgementIf you think you may have received an incorrect Medicare benefit or payment, you can voluntarily tell us. If you voluntarily acknowledge an incorrectly claimed benefit, you may be entitled to a reduced administrative penalty.
To do this you must complete the Voluntary acknowledgement of incorrect payments form.
Review of decisionIn some circumstances you can apply to review the decision of a Medicare compliance audit or review if you are advised to repay an incorrectly claimed benefit or payment.
You can do this by completing the Application to Review Compliance Audit Decision form.
You must apply to review a decision within 28 days of receiving notice that an amount is owing.
Record keepingIf you provide or initiate a service where a Medicare benefit is payable you should make sure you keep adequate and up to date records.
- clearly identify the name of the patient
- have a separate entry each time the patient has attended a service
- include the date the service was provided or initiated
- contain enough information to explain the type of service provided
- be clear enough so another practitioner, relying on the record, could effectively undertake the patient's ongoing care
- be up to date, making sure it's completed at the time the service was provided or as soon as possible afterwards, and
- be in either paper or electronic form