Administrative penalties

This page includes information about administrative penalties in relation to health payment compliance requirements.

Page last updated: 29 August 2018

Administrative penalties

Penalties may now apply to incorrect payments or unsubstantiated services for which a benefit has been paid under the following Acts:

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Administrative penalties

If you owe more than $2,500 as a result of compliance action (for services which have been incorrectly paid or not substantiated) an administrative penalty may now apply.

Administrative penalty rates

Penalties are an inducement to encourage voluntary compliance with the legislative requirements.

The legislation outlines the circumstances under which a penalty can be reduced or increased under each Act. An administrative penalty is calculated as a percentage of the amount a health professional owes for each incorrect payment or unsubstantiated service. For all three health Acts, the base penalty is 20 per cent of the debt owed.

Reductions to administrative penalties

If we contact you about services you have provided and you tell us that the payments for those services should not have been made, the administrative penalty may be reduced, depending on when you tell us about an incorrect claim or payment.

For the HIA and DBA

The base penalty can be reduced from 20 per cent to:

  • zero, if you tell us about incorrectly claimed or paid benefits, before we contact you
  • 10 per cent, if you tell us about an incorrect claim or payment after we contact you and before you receive a formal Notice to Produce documents
  • 15 per cent, if you tell us about an incorrect claimed or paid benefit after you have received a formal Notice to Produce documents and before the date specified in the notice.
    • For the NHA
      The base penalty can be reduced from 20 per cent to:

      • 10 per cent, if you tell us about an incorrect claimed or paid benefit after you have received a formal Notice to Produce documents and before the date specified in the notice.

      The Voluntary Acknowledgement of Incorrect Payments Form is how you tell us about incorrectly claimed or paid benefits.

      Increasing administrative penalties

      Under both the HIA and the DBA, if you don’t respond to the formal Notice to Produce documents before the date specified in the notice the base penalty can be increased by up to 30 per cent of the total debt.