The Department of Health, Disability and Ageing (DoH) is responsible for ensuring the integrity of Australian Government health program payments including the Medicare Benefits Schedule (MBS). They support integrity through the prevention, early identification, and treatment of incorrect claiming, inappropriate practice, and fraud.

The DoH has notified the ANZSVS of an upcoming compliance activity which may impact some members who have claimed MBS Services whilst overseas. See Vascular Surgery Group Findings 1 October 2022 to 30 April 2024

While the DoH’s focus is to support providers in understanding their obligations when claiming Medicare benefits, notification of these issues forms part of the 2025 Health Provider Compliance Priorities and serves as a warning. It is likely individual practitioner audits will follow.

Where routine data suggests a claiming concern, members may be asked to perform a clinical audit and substantiate claims or explain how errors occurred. Providers may be asked to pay back claims if there is a pattern of systemic abuse.

Members are asked to review their billing practices to ensure compliance.

Mechanisms by which some unintended claims may arise:

  • Incorrect date inadvertently placed on claim
  • Inadvertent items submitted placed on claims while the doctor is away
  • “Group practices” with Business models where a given doctor is ascribed to reported the service (e.g. a regular day of the week)
  • Where a locum is employed to cover the practice but for simplicity (staff workflows) the claims are submitted through practice software using established / existing provider number
  • Medicare claims made by public hospital administrative staff (private practice billing teams) for public hospital outpatient services and imaging facilities
  • Corporate practices where a vascular surgeon is employed to remotely report studies at multiple sites (and their leave may not have been taken into account).
  • Doppler tests (ABPI’s) may have been done by practice nurses and might have inadvertently occurred or been billed while the doctor was away

You can learn more about the DoH’s risk-based and proportionate compliance approach in the Health Provider Compliance Strategy 2025-30.

Questions or comments should be directed to the MBS Review Subcommittee on email [email protected]