Note: Where available, the PDF/Word icon below is provided to view the complete and fully formatted document
Medicare compliance program saves $250 million.

Download PDFDownload PDF

MEDIA RELEASE Senator the Hon Joe Ludwig Minister for Human Services

Thursday 4 September 2008

Medicare compliance program saves $250 million

Medicare Australia’s compliance activities saved the Australian taxpayer at least $250 million last financial year, according to figures released today by the Minister for Human Services, Senator Joe Ludwig.

Senator Ludwig has also released Medicare Australia’s latest plan for more savings this financial year by helping doctors, other health providers and the public claim correctly.

Medicare Australia’s National Compliance Program 2008-09 is based on greater education to encourage a culture of compliance. It aims to: • Promote more involvement from health professionals • Improve information and education programs

• Reduce complexity by streamlining processes • Refine the systems Medicare uses to verify payments

“The Australian Government is working hard to protect the integrity of its programs and ensure the right person receives the right payment at the right time,” Senator Ludwig said.

“This effort resulted in at least $250 million in savings for taxpayers last financial year - $25 million from the Medical Benefits Scheme and around $225 million from the PBS.”

“The majority of these savings were a result of reducing incorrect claiming - but almost $7 million was also recovered from individuals and organisations.”

“Medicare Australia finalised 600 investigations last financial year. These included cases relating to 223 medical practitioners, 42 pharmacists and 330 members of the public,” Senator Ludwig said.

OTHER 2007-08 PROGRAM FACTS: • Medicare Australia is currently investigating 209 individuals for suspected fraud. • Medicare has referred 74 individuals to the Commonwealth Director of

Public Prosecutions. • The CDPP successfully prosecuted 51 individuals. • Medicare Australia received almost 2230 tip-off calls.

“The 2008-09 program is backed up by the first significant investment in Medicare compliance activities in more than 10 years,” Senator Ludwig said.

Earlier this year, the Australian Government allocated Medicare Australia an additional $76.9 million over four years to increase audit activity.

Medicare Australia’s compliance arm will focus on inappropriate billing of Medicare Benefits Schedule items, including upcoding by medical practitioners, the removal of skin lesions, flap repairs and some time-based attendance items.

More education will also take place on the Prescription Shopping Program, to help doctors make informed decisions about patients suspected of obtaining PBS medicine in excess of medical need.

“In 2007-08, Medicare Australia sent letters to or met with 7700 doctors regarding patients suspected of getting medicine in excess of medical need,” Senator Ludwig said.

“Medicare Australia processes over 500 million transactions and pays more than $30 billion in benefits and incentives each year.”

“A range of enforcement options are available to reduce inappropriate practices, over-prescription and attempted fraud.”

“When honest mistakes are made, people will be given appropriate support, as well as the opportunity to explain or rectify their error.”

“However, those who choose to deliberately abuse the health care system through fraudulent activity will feel the full force of the law.”

“Medicare Australia will continue to develop its education programs, streamline delivery processes and make it easier for health care providers and Australians to deal with the agency in relation to compliance issues.”

“Medicare Australia has developed this new compliance program in extensive consultation with health care professionals, to understand their concerns,” Senator Ludwig said.

For more information, or to download a copy of Medicare Australia’s National Compliance Program for 2008-09, please visit

Minister’s Media Contact: Joe Scavo 0413 800 757