We perform investigations when there are any concerns of fraud by providers.
We investigate any concerns about fraud by providers against:
- the Medicare program
- the Pharmaceutical Benefits Scheme
- other government programs.
Examples of fraud
- A pharmacist claiming for medications which were not supplied to the patient.
- A practitioner claiming for services which have not taken place.
How we conduct investigations
We conduct investigations in accordance with the Australian Government Investigation Standards and the Commonwealth Fraud Control Framework. We also undertake voluntary interviews with providers under investigation.
If necessary, we can use powers under the Human Services (Medicare) Act 1973 to get information. This includes issuing notices, requiring the production of information, and search warrants.
For some investigations, we liaise with the police. We refer matters to the Commonwealth Director of Public Prosecutions for possible criminal prosecution.