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Medicare Australia's 2009-10 National Compliance Program.

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MEDIA Release Chris Bowen MP Minister for Human Services Minister for Financial Services, Superannuation and Corporate Law


The Minister for Human Services, Chris Bowen MP, today released Medicare Australia’s compliance program for the year ahead—a plan expected to recoup $300 million for the taxpayer in this financial year.

Medicare Australia’s National Compliance Program 2009-2010 protects taxpayer dollars by encouraging health professionals and members of the public to claim medical and pharmaceutical benefits correctly.

“Each year Medicare Australia pays over $30 billion on behalf of the Australian Government, so we need to ensure the right payments are going to the right people, whether they’re a medical practitioner, pharmacist or patient,” Mr Bowen said.

“While most people do the right thing, some need to be informed on how to claim correctly. There’s also a small percentage that take advantage of the system to fraudulently obtain benefits.

“These savings will be achieved through the recovery of payments incorrectly claimed, changes to services and prescribing behaviours, and the wider deterrent effect of having a robust compliance presence.

“This compliance program, with its appropriate balance of education, support, deterrence and audit activities, is designed to encourage voluntary compliance.

2008-2009 HIGHLIGHTS:

• Medicare Australia conducted almost 2,800 audits of practitioners, pharmacists and members of the public to identify incorrectly claimed Medicare or pharmaceutical benefits. • The audits showed $6.18 million needed to be repaid, including $4.5 million from 756 practitioners. • Medicare Australia conducted 124 investigations into suspected fraudulent behaviour and 48

successful prosecutions, including 43 members of the public convicted of offences ranging from altering documents, identity fraud, claiming for services not received and obtaining more Pharmaceutical Benefits Schedule (PBS) medicine than needed. • Four practitioners were prosecuted for fraudulently claiming Medicare services not provided, while one pharmacist was convicted for intentionally claiming PBS medicine not supplied.

“The Rudd Government has shown a strong commitment to strengthening Medicare Australia’s compliance activities—we’ve funded increased audits which began in January this year, and we’re pushing for further audit powers with the new Compliance legislation,” Mr Bowen said.

“When honest mistakes are made, people will be given the opportunity to explain or fix their error; however, those who intentionally defraud taxpayers will face the consequences.”

In relation to general practice, this year’s compliance program will be focusing on incentive payments, up-coding (where the practitioner bills for a more expensive item than actually provided) and high risk practitioners.

Specialists whose billing patterns differ significantly from their peers could have their claiming behaviour reviewed; while allied health professionals will attract increased audit attention this year.

Medicare Australia will monitor pharmacists to ensure that those who claim the same prescription more than once or continue to claim benefits for pharmaceuticals supplied after date of death will be asked to repay PBS benefits.

Medicare Australia will continue to identify and prosecute members of the public who fraudulently claim benefits and obtain more PBS medicine than needed.

“I encourage anyone who suspects fraud or non-compliance in relation to government payments to contact the Australian Government Fraud Services Tip-Off Line on 13 15 24,” Mr Bowen said.

For more information, or to download a copy of Medicare Australia’s National Compliance Program 2009-2010, visit

Media Contact - James Cullen 0409 719 879