Improving Medicare compliance - Legislative change consultation

Closed 8 Oct 2017

Opened 15 Sep 2017

Overview

In the 2017-18 Budget, the Government announced that it would be introducing legislation to strengthen Medicare compliance, including to:

  • address billing practices associated with the increasing corporatisation of medical practice;
  • improve debt recovery rates; and
  • streamline administrative processes associated with billing and compliance.

The Department of Health (the Department) is now seeking stakeholder input into the proposed changes to the Health Insurance Act 1973, the National Health Act 1953 and the Dental Benefits Act 2008. These three Acts govern the Medicare Benefits Schedule (MBS), the Pharmaceutical Benefits Scheme (PBS) and the Child Dental Benefits Scheme (CDBS) respectively.

The nature of health practice is changing from small owner-operated medical practices to larger business enterprises. However, the current legislative framework is focused on individual providers, rather than the corporate entities and organisations that are increasingly billing Medicare on their behalf.

Providers under the MBS continue to receive full payment of benefits while they have outstanding debts arising from incorrect claiming, inappropriate practice and in a very small number of cases, fraud. Compulsory offsetting powers under the National Health Act 1953 and the Dental Benefits Act 2008 allow such debts to be compulsorily recovered for PBS and CDBS debts. It is proposed that compulsory offsetting of up to 20 per cent of future payments be applied to the MBS.

Other inconsistencies among the three Acts mean that doctors and other MBS providers, pharmacists and dentists face different accountabilities and penalties for similar actions. These inconsistencies include record keeping requirements, administrative penalties and requirements to produce documentation to support claiming.

The proposed legislative changes are to harmonise compliance and administrative arrangements across MBS, PBS and CDBS to ensure consistency in approach for pharmacists, dentists, doctors and other health providers.

It is proposed that the Health Insurance Act 1973 (HIA), the National Health Act 1953 (NHA) and the Dental Benefits Act 2008 (DBA) be amended to:

  • better address the reality of practices, corporations and hospitals billing on behalf of individual providers;
  • allow the Department to offset up to 20 per cent of future MBS payments made to providers who have debts to Medicare; and
  • improve the consistency of administrative arrangements across the three Acts.

How to participate - Submit feedback

  • Read the discussion paper
  • submit your feedback through the online survey
    or
  • upload a response.

There is an option on each page of the survey to upload a response, however this is not mandatory.

Please note:

  • You can save your submission and return to it at a later time.
  • Submissions cannot be modified after they have been submitted.
  • Only one submission from each group is permitted/allowed/required.

What Happens Next

The department will publish a summary of submission feedback once all submissions have been received and considered.

Audiences

  • Health professionals

Interests

  • Hospitals
  • Medicare
  • Legislation
  • Pharmaceutical benefits
  • Dental health