About
The 2026–27 Budget includes $146.8 million over 4 years to strengthen Medicare integrity. This funding will reduce fraud and incorrect claiming.
This work builds on earlier reforms from an independent review of Medicare integrity (Philip Review). These reforms created a strong base. We need to do more to manage integrity risks.
Who this affects
Medicare is Australia’s universal health insurance scheme. It covers essential health services for Australians and eligible overseas visitors.
These measures will benefit:
- patients who use Medicare
- health practitioners and providers.
What is included
- Better support to help providers claim correctly under Medicare (MBS) and the Child Dental Benefits Schedule (CDBS).
- Improved systems, including better visibility of claims made under a provider number.
- Easy access to training, information and support.
- Better detection of unusual Pharmaceutical Benefits Scheme (PBS) claims.
- Stronger upfront controls to reduce incorrect or fraudulent payments.
- Changes to laws to support a fairer and more balanced approach to compliance.
- Improved claim reports for patients, so they can see services billed using their information.
What this work will do
- Support a sustainable Medicare system.
- Reduce fraud and wrong claims.
- Make Medicare easier to use correctly and harder to misuse.
Who we work with
We work closely with Services Australia and key medical and health peak bodies, as well as other government agencies. Working together helps improve Medicare integrity.
Next steps
We will continue to work with our stakeholders to manage meaningful integrity reforms and improvements.
We are planning how the work will be delivered and how we will keep stakeholders informed. Updates will be shared on this page.
Learn more
- Medicare Integrity – Key Achievements
- Independent Review of Medicare Integrity and Compliance (Philip Review)
- Independent Review of Medicare Integrity and Compliance (Philip Review) – Final report
- What we're doing about Medicare
- Review of Medicare Integrity and Compliance – Terms of reference
Contact
Contact us if you have any questions, feedback or concerns. We will respond as soon as possible.
