Compliance for health professionals
- Administrative record keeping guidelines for health professionals
- Billing accurately under Medicare
- Compliance and fraud investigation
- Health professional guidelines
- Large Practices Project
- Medicare billing assurance toolkit
- Medicare compliance audits and reviews
- Practitioner review program
- Provider percentile charts
Information, assistance and education information on the appropriate use of the Medicare Benefits Schedule, the Pharmaceutical Benefits Schedule and other health programmes.
Compliance activities are focused on early intervention and prevention to help you get your correct entitlements, and assist you to meet your obligations and responsibilities. These activities target areas of inappropriate practice and fraudulent activity. Prosecution is considered where fraud is identified.
We work with you to resolve any issues, if you have not complied with reporting requirements because of genuine mistakes.
Where we identify incorrectly claimed benefits, we will seek to recover the money.
We work very closely with a wide range of stakeholders to ensure they are well informed on all aspects of our compliance approach.
We apply a balance of education and compliance strategies to meet legislative requirements. The Human Services (Medicare) Act 1973 sets out the functions and powers to administer Medicare. It also defines the programmes that fall under the Medicare service delivery brand.
The legislation that governs our 2 main health payment and services programmes are:
- Health Insurance Act 1973
- Dental Benefits Act 2008
- Public Governance, Performance and Accountability Act 2013
- Veteran’s Entitlement Act 1986
- Health and Other Services (compensation) Act 1995
- Privacy Act 1988
- Privacy Amendment (Enhancing Privacy Protection) Act 2012
- Aged Care Act 1997
- Private Health Insurance Act 2007
- National Health Act 1953
- Drug and Poisons Act and Regulations applicable in the States and Territories
- National Health (Pharmaceutical Benefits) Regulations 1960
The legislation that makes us accountable for the payments we administer under Medicare is the Public Governance, Performance and Accountability Act 2013.
Read more about the Department of Human Services Compliance Program 2013-15.
To provide feedback on health compliance, email email@example.com.