Australian Government publishes Medicare Health Provider Compliance Strategy 2025-30
The strategy relates to payments made under Medicare programs and outlines the government’s risk and proportion-based approach to compliance.
The strategy aims to prevent incorrect claiming, support providers to get it right, and effectively address non-compliance when it occurs. ANZCA members are encouraged to review the strategy where their role relates to Medicare billings.
Compliance priorities for 2025 include:
- Bulk billing
- Specialist and consultant physician claiming of attendance items and management plans
- Claiming MBS services while overseas
- Suspected fraud
- Duplicate payments
- Opportunistic billing and emerging business models
- Inappropriate claiming of high-cost PBS medicines
- Open and uncertified PBS claims.
Further information on the Medicare compliance approach is located here, with the strategy located here and the strategy’s 2025 compliance priorities located here.
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