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Legislation introduced as part of increased Medicare Compliance Audits initiative.



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CHRIS BOWEN MP MINISTER FOR HUMAN SERVICES MINISTER FOR FINANCIAL SERVICES, SUPERANNUATION & CORPORATE LAW

MEDIA RELEASE

17 September 2009

LEGISLATION INTRODUCED AS PART OF INCREASED MEDICARE COMPLIANCE AUDITS INITIATIVE

The Minister for Human Services, Chris Bowen MP, today introduced into the parliament the Health Insurance Amendment (Compliance) Bill 2009 that will enhance the compliance program for the Medicare scheme.

The Bill gives effect to the Increased MBS Compliance Audits initiative which was announced in the 2008-09 Budget.

“Expenditure on the Medicare scheme was over $14 billion in 2008-09 and has grown by more than $1 billion per annum over the last two years,” Mr Bowen said.

“Medicare Australia conducts compliance audits of medical practitioners to ensure that taxpayers’ money is spent appropriately.

“This legislation will ensure that Medicare Australia has the authority to require the production of relevant documents, and can confirm that the Medicare payment is correct.

“At present, many practitioners voluntarily cooperate with Medicare Australia during a compliance audit, however, on average 20% of practitioners either do not respond to or refuse to cooperate with a request for documents.”

The Report of the Senate Community Affairs Legislation Committee Inquiry into Medicare Compliance Audits recommended that regulations be developed to ensure that patient clinical records are only required to be accessed where necessary during a compliance audit.

“The Government has carefully considered the Senate Committee’s recommendations and has worked closely with key medical and privacy stakeholders to make important changes to the draft legislation,” Mr Bowen said.

The Bill has been amended so that:

• the Medicare Australia CEO must take advice from a Medical Adviser and give the practitioner the opportunity to voluntarily comply

with an audit request before a notice to produce documents can be issued; • a person who is given a notice will be informed that they are not required to produce documents containing clinical details unless these are necessary to substantiate the service; • where it is necessary to produce documents containing clinical details, these documents can be provided to a Medical Adviser rather than to an administrative compliance auditor; • where a practitioner is found to owe a debt they will be given 28 days in which to seek internal review of the decision before a debt notice is issued.

“At present, when a practitioner is found to have wrongly billed a Medicare item, they are required to pay it back,” Mr Bowen said.

“This Bill provides that a practitioner may also be required to pay a financial penalty.”

The financial penalty will be reduced or increased in response to voluntary admission, cooperation, and failure to comply with a notice and recidivist behaviour.

Media Contact - James Cullen 0409 719 879