The high-level document lists ‘cooperation between individuals and/or entities to inappropriately maximise payment of benefits’ as an area of interest.
The Department of Health, Disability and Ageing has now published the Health Provider Compliance Strategy for 2025-30, in which it lays out objectives like “preventing incorrect claiming” and “supporting providers to get it [claiming] right”.
It appears that there was an earlier version of this document – there are references to the new strategy in our own reporting from April and in medical college releases from May – but the current DoHDA website only lists it as having been published on Thursday 25 September.
The Medical Republic was unable to locate any in-depth reporting of this original document, so it is unclear whether there were any changes made since its original publishing, and how extensive those may have been.
According to the strategy, the combined spend on the MBS, PBS and Child Dental Benefits Schedule amounts to about $48 billion in taxpayer funding each year.
“The Department of Health, Disability and Ageing … is responsible for ensuring compliant health provider claiming under each of these programs,” it read.
“We support integrity through the prevention, early identification, and treatment of incorrect claiming, inappropriate practice and fraud.”
Related
Its objectives, meanwhile, include bringing a “risk-based and proportionate approach” to compliance.
The three aims listed in the strategy are: preventing incorrect claiming by making it hard to get it wrong, enabling correct claiming by supporting providers to get it right and effectively addressing non-compliance when it occurs.
Broader themes for non-compliance are incorrect claiming, incorrect prescribing, possible inappropriate practice, fraud and business arrangements that seek to inappropriately maximise payment of benefits.
This last extends to agreements between individuals or businesses to inappropriately maximise payment of benefits.
In terms of compliance approach, the strategy says DoHDA uses evaluation and behavioural insights to design approaches to manage non-compliance.
It also aims for a proportionate response based on the seriousness and scale of the identified issue.
