Increased Medicare Compliance Audits (IMCA)
In the 2008–09 Federal Budget, the Australian Government announced its plan to enhance the Medicare Benefits Schedule (MBS) audit process undertaken by the Department of Human Services—referred to as the Increased Medicare Compliance Audit (IMCA) Initiative.
Part of this initiative involved the development of amendments to the Health Insurance Act 1973. The amendments are contained in the Health Insurance Amendment (Compliance) Act 2011 (the Act), which was recently passed by the Australian Parliament. The Act which started on 9 April 2011 and relates to Medicare services provided on or after this date.
Key features of the Act are:
- the Department of Human Services can now issue a notice to health professionals, or a person in charge of the professional’s records, if there is a reasonable concern that a Medicare benefit has been paid that exceeds the amount that should have been paid. This notice will require a health professional to produce documents to substantiate services
- an administrative penalty with a base rate of 20 per cent for unsubstantiated amounts that total more than $2500 has been introduced. This penalty may be decreased where a health professional voluntarily cooperates with an audit, but can be increased where a health professional does not cooperate
- health professionals can seek a review of a decision from the Department of Human Services to recover funds where a Medicare service has not been substantiated.
The Act only applies to professional services provided on or after 9 April 2011.
For more information about the changes to the legislation, see the Increased Medicare Compliance Initiative (IMCA) Resources page.
Last updated: 4 March, 2013