About the reforms
In response to the Independent Review of Medicare Integrity and Compliance (Philip Review), we established the Medicare Integrity Taskforce on 1 July 2023.
The Philip Review investigated the integrity of Medicare and highlighted the complexities of the Medicare program. The review also showed it is important to ensure Medicare’s legislation, governance, systems, processes and tools are effective.
The taskforce is working to progress reforms to improve the integrity of Medicare in line with the review.
Who the reforms affect
Medicare is Australia’s universal health insurance scheme. Funded by the Australian Government, it provides free or subsidised healthcare services to Australians and eligible overseas visitors.
Medicare integrity reforms benefit anyone who uses Medicare. This includes people receiving healthcare and healthcare providers.
Why the reforms are important
Medicare began in 1984. It aims to give eligible Australians and eligible overseas visitors affordable, accessible and high-quality health care.
The taskforce’s work to improve and strengthen Medicare’s integrity is important as it supports a sustainable Medicare, and better health outcomes for Australians.
Goals
Medicare integrity reforms aim to:
- ensure Medicare is sustainable
- improve how we find, reduce and prevent non-compliant claiming
- make Medicare easier to comply with and harder to exploit.
Who we work with
The taskforce has been working with Services Australia and key medical and health peak bodies, as well as consulting with other government agencies. Working closely with stakeholders makes sure the taskforce considers a range of ideas and perspectives. This is important for improving the integrity of Medicare.
The taskforce will continue to work with our stakeholders to manage meaningful integrity reforms and improvements.
Outcomes
Key reforms delivered to date include:
- changing legislation in line with Philip Review recommendations
- increasing fraud reduction measures to strengthen Medicare integrity
- introducing some system checks that help stop payment of certain claims when they are incorrect
- developing tailored education and information resources to help Medicare users to understand the rules
- building new data models to find fraud and non-compliance faster
- improving how we work with Services Australia to protect the integrity of Medicare.
We also improved the Report suspected fraud online form, which you can use if you have anything to report. This can be about suspected fraud involving:
- health providers
- activities funded by our department such as services, grants and other payment
- our staff.
September and November 2023
Legislative changes to the Health Insurance Act 1973 took effect in September 2023 and November 2023. The changes have strengthened Medicare’s compliance functions, including to:
- improve operation of the Professional Services Review (PSR) Agency, an important regulator for the Medicare program
- create associate director positions to support the PSR’s workload
- improve our department’s audit process.
July 2024
We introduced a fraud-reduction measure on 1 July 2024. This means we made changes to the timeframe certain claims can be made under the:
- Medicare Benefits Schedule (MBS)
- Child Dental Benefits Schedule (CDBS).
September 2024 and June 2025
In the 2024–25 Strengthening Medicare Budget, the Australian Government authorised the taskforce to work on Medicare claiming controls. The controls introduced claiming restrictions for specific items to ensure they can't be incorrectly claimed.
We introduced Part 1 of this control on 1 September 2024 and Part 2 on 1 June 2025.
November 2024
We published the new Understanding Medicare: Provider Handbook on 25 November 2024. This handbook is a plain English guide that details the fundamental elements and principles of Medicare. It provides direction for healthcare professionals and others using the Medicare system.
November 2024 and February 2025
The Medicare Integrity Bill was introduced into Parliament in November 2024 and passed the House of Representatives in February 2025.
The Bill proposes reforms that would improve abilities to respond to and address incorrect claiming, recover funds, deter inappropriate practice, and support existing regulatory schemes.
March 2025
We provided advice to our compliance colleagues as they developed the Health Provider Compliance Strategy 2025–30. The strategy goes hand in hand with taskforce’s work to encourage and promote a strong integrity culture.
Learn more
- 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
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