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News

Australian Government publishes Medicare Health Provider Compliance Strategy 2025-30

5 min read

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