What to report to us
Let us know if you think someone has claimed a Medicare or Pharmaceutical benefit incorrectly. This may include claiming for a service which was not provided, or not meeting the requirements for claiming.
The kinds of payment concerns to report to us include:
- Medicare benefits via the Medicare Benefits Schedule (MBS).
- Pharmaceutical benefits via the Pharmaceutical Benefits Scheme (PBS).
- Child Dental Benefits Schedule (CDBS) payments.
- Payments for through incentive programs including the Practice Incentive Program (PIP) and Workforce Incentive Program (WIP).
- COVID-19 vaccination issues related to the charging of out of pocket costs, or the billing of additional Medicare items in general practice.
- Charging for COVID-19 vaccinations by general practices.
We accept tip-offs about:
- doctors, pharmacists, dentists and allied health professionals such as physiotherapists
- pharmacies, medical practices, hospitals and administrative staff.
If you see a name you don't know on your Medicare statement
Your Medicare statement includes a list of Medicare services which have been claimed, and the practitioner who claimed the service.
Most of us recognise our doctor’s name, so it’s not unusual to be concerned if you see a name you don’t recognise on your Medicare statement.
If this happens, consider whether you might have had a service, such as an eye test, pathology, or diagnostic imaging, from someone other than your usual provider. Pathology tests are claimed by the medical practitioner who reports the result, not the person who collected the sample.
What to report to someone else
There are some things we can’t investigate.
You can report these things to other authorities:
- Reports about fake vaccine certificates – submit these to Services Australia (Proof of COVID-19 vaccinations for businesses - Running a business - Services Australia)
- Reports about patient safety or harm – submit these to the Australian Health Practitioner Regulation Agency (AHPRA).
- Rude, racist, inappropriate professional conduct, not listening, dismissive service quality or interaction issues (also AHPRA).
- Suspected Medicare, pharmaceutical or Centrelink fraud by a member of the public (not a health provider or their employee) – This includes concerns about stolen Medicare cards or that you have been advised that your Medicare details have been affected by the Optus breach – submit these to Services Australia.
- Concerns about aged care services – submit these to the Aged Care Quality and Safety Commission (ACQSC).
- Medicine on-selling by a member of the public – contact your state police.
- Claims made to your private health insurer – report to your own health insurance fund.
- COVID-19 vaccination issues in pharmacies: submit these to the Pharmacy Program Administrator PPA tip-off form.
How to submit a tip-off
You don’t have to give us your details when you submit a tip-off.
But it helps if you do, so we can contact you for more information if we need it.
If you want to make a report, call our hotline.
Or, if you can’t call the hotline, use our tip-off form.