Voluntary acknowledgement of incorrect payments

Use this form to acknowledge incorrect payments of Medicare benefits, Child Dental benefits and other payments that have been made to you by Medicare.

The VA form may be used to correct claiming errors identified through a Department of Health, Disability and Ageing compliance activity, or where you have identified a broader pattern of incorrect claiming over an extended period. 

If we have contacted you about your claiming, prescribing, requesting, or any other matter relating to the Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS), Child Dental Benefits Schedule (CDBS) or Practice Incentives Program (PIP), you should use the VA form to disclose any incorrect payments identified as part of your review. 

Requests to adjust or delete ad hoc self-identified claiming errors relating to an individual claim, or a small number of claims, should be lodged directly with Services Australia. 

Voluntary acknowledgement form

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