About the review
On 5 November 2022, the Minister for Health and Aged Care announced an independent review into Medicare integrity and compliance. It focused on the Medicare payment system and the integrity of claims for payment. Health economist Dr Pradeep Philip led the review.
Terms of reference
We created the terms of reference to define the scope of the review and outline the 3 main outcomes.
Why it is important
Medicare is a national scheme that provides Australians, and some overseas visitors, with free or subsidised health services. Protecting and strengthening the integrity of Medicare is important. Doing this keeps public health services low cost, high quality and available for all Australians.
Goals of the review
The review aimed to:
- assess the potential value of non-compliance across the Medicare system
- find possible integrity risks in the Medicare payment system
- provide options to improve payment controls, compliance treatments and legislation.
The review also aligns with what we're doing about Medicare.
Outcomes
Final report
The Minister for Health and Aged Care received the final report of the Philip Review in April 2023. It provided a series of findings and recommendations to improve parts of the Medicare system. This includes recommendations to:
- improve governance
- strengthen Medicare’s claim systems
- use tools to detect and address non-compliance and fraud
- create educational resources for providers
- better share information
- progress legislative changes.
- The review also recommended ways to improve compliance processes.
Response to the review
The Australian Government responded to the Philip Review in the 2023–24 Federal Budget by providing funding to start a Medicare Integrity Taskforce. The taskforce was formed to:
- assess and work through the review findings and recommendations
- provide advice to government on the findings and recommendations
- implement and oversee initial improvements to Medicare integrity.
Funding for the taskforce was extended in the 2024–25 Federal Budget for 2 more years until June 2026.
More information
Learn more about what we're doing to improve Medicare integrity and progress reforms.
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