Medicare compliance

Find information about how we manage Medicare compliance programs, what your obligations are and how to comply with them, and what to do if you think you've incorrectly claimed.

  • About Medicare compliance

    Our compliance program helps to ensure all Medicare claims are correct and legitimate. This helps keep our healthcare system sustainable and ensures we remain accountable to Australian taxpayers for payments we make under Medicare.
  • When Medicare compliance applies

    Legislative requirements apply to health practitioners who bill, claim, dispense and prescribe under the MBS, CDBS and PBS, and to organisations receiving PIP payments.
  • How to comply with Medicare obligations

    As a health practitioner, it is your responsibility to comply with Medicare obligations. It’s important to do the relevant training and understand the requirements and laws that apply. We provide lots of education and support to help you meet your obligations.
  • Our Medicare compliance activities

    We are accountable for payments made under Medicare programs. We review and audit health practitioners’ claims to make sure they are legitimate. We support health practitioners to comply with Medicare requirements, with a focus on prevention and early intervention.
  • Voluntary acknowledgement of incorrect payments

    If you think you've incorrectly claimed a Medicare or practice incentive payment, you must let us know as soon as you can. You can do this by submitting a voluntary acknowledgement of incorrect payments form.
  • Non-compliance debts and penalties

    You must repay any incorrect payments made to you under Medicare. You might also have to pay additional penalties. How you work with us can decrease or increase any penalty amount.
  • Reporting incorrect billing, claiming, or suspected fraud

    We protect the integrity of health programs by making sure that correct payments are made for the right services. If you think a doctor or pharmacist has charged you, or claimed for, a service or product you didn’t receive, let us know here.
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