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Significant changes to legislation set to improve Medicare compliance

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By Rhiannon Riches
Communications Manager

 

Health professionals are now required to keep records for a minimum of two years including referrals and documents created as a condition of claiming an MBS item, following key changes introduced to the Health Insurance Act on 1 July 2018.

The Department of Health has issued a notice of changes to legislation as part of its program to prevent, identify and treat incorrect claiming, inappropriate practice and fraud by health care providers and suppliers.

‘Important changes were introduced on 1 July 2018 to help the department ensure that Medicare is serving the needs of Australian patients. These changes amended various sections of the Health Insurance Act 1973, the Dental Benefits Act 2008, and the National Health Act 1953,’ the Department stated.

One of the major changes will come into effect from 1 July 2019, when the Shared Debt Recovery Scheme will commence.

The scheme will allow the department to hold an employing organisation responsible for a portion of debts incurred as a result of incorrect Medicare claiming.

‘To assist in this, information about a health professional’s employer or contracting organisation will now be required when applying for a provider number,’ the department stated.

According to the department, the one-year delay in the scheme’s introduction allows for consultation with peak bodies to generate regulations under which the scheme will operate.

From 1 July 2018, additional key changes to the Health Insurance Act include:

  • The department can issue a Notice to Produce as part of a compliance activity, which requires a health professional or organisation to produce documents relating to items claimed. Before issuing the notice, the department must first provide an opportunity for the health professional or organisation to respond to compliance concerns and provide substantiation of claims.
  • If a health professional or organisation voluntarily acknowledges incorrect claiming, either before compliance activity or before a Notice to Produce has been issued, financial penalties will be reduced.
  • Financial administrative penalties can be applied to a debt of more than $2,500 if substantiating documents are not provided, or not provided within the required timeframe.
  • Improved debt recovery mechanisms that allow the department to offset or deduct a debt owed from amounts payable to the debtor or to garnishee debts from a debtor’s bank account.

For more information, view the Improved Medicare Compliance: Changes to Legislation for Health Professionals Fact Sheet.

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