We data match to improve the detection of incorrect claiming, possible inappropriate practice and fraud.
The National Health Act 1953 (National Health Act) enables us to undertake data matching, in specific circumstances, for a permitted purpose.
The National Health Act provides authority for the Chief Executive Medicare (CEM) to match defined sets of data for permitted purposes, which relate to Medicare compliance. It also allows the CEM to authorise another Commonwealth entity to match data on the CEM's behalf for a permitted purpose.
The National Health Act requires the Minister for Health to make a legislative instrument in relation to the matching of data. This legislative instrument is called the National Health (Data-matching) Principles 2020 (Principles). It sets out governance requirements for data matching that help to provide transparency and accountability of data matching activities.
The Principles require:
a public Data Matching Program Notice to provide transparency and awareness of data matching
a Public Register to be published to describe the kinds of information matched by the CEM, or authorised Commonwealth entity on behalf of the CEM.
Data Matching Program Notice and the Public Register
The data matching arrangements do not expand our powers to conduct health provider compliance activities. Nor do they change our approach in conducting compliance activities.
Purpose of data matching
The purpose of data matching for Medicare compliance purposes is to improve our ability to match and share data to identify fraud and incorrect or inappropriate claiming. Data matching will not authorise the automation of compliance outcomes or raising of debts. It is an identification tool for our compliance officers to continue to follow prescribed and legislated compliance processes.
We comply with Australian Government security policies such as the Attorney-General Department's Protective Security Policy Framework and the Department of Defence's Information Security Manual. Data is transferred securely and may only be matched in secure environments. Data is subject to strict security controls, and can only be accessed by suitably authorised staff when required for their duties.
Data matching does not impose any changes or new obligations on health providers in relation to their Medicare billing requirements.