IMCA Resources
The Health Insurance Amendment (Compliance) Act 2011 amends the Health Insurance Act 1973 and introduces new laws that relate to services rendered on or after 9 April 2011. There are now changes to obligations and procedures for Medicare compliance audits for incorrect payments and unsubstantiated services. To help you understand these changes, the following resources have been developed:
Fact sheet
The fact sheet provides information about the changes to the Health Insurance Act 1973, including details on the new compliance audit notices you may receive, the opportunity for you to request a review of a decision and administrative penalties that can apply.
Medicare compliance audit flow chart
The flow chart provides a graphical overview of a Medicare compliance audit reflecting changes to the legislation.
Frequently Asked Questions (FAQ)
The FAQs answers questions you may have about the changes to the legislation and how you may be affected by a Medicare compliance audit.
Administrative and civil penalties
Under the changes to the Health Insurance Act 1973, penalties may now apply to incorrect payments or unsubstantiated services. There is a penalties FAQ sheet to help you understand the administrative and civil penalties that may apply.
Note: Penalties do not apply to debts that became due more than two years prior to an audit or to services claimed before 9 April 2011.
Voluntary Acknowledgement of Incorrect Payments form
Should you become aware of any incorrect payments you may have received under the Medicare program, you can now voluntarily tell the Department of Human Services. To do this you must fill out the approved Voluntary acknowledgement of incorrect payments form. This form can be used at any stage you become aware of receiving an incorrect payment.
Review of Decision form
The new laws give you the opportunity to seek a review of a decision if you do not agree with a decision to recover amounts. The request for a review of decision must be received within 28 days of receipt of a notice of decision.
To request a review of decision you must complete the approved Review of Decision form.
If you have feedback in relation to a Medicare compliance audit finding then please email: compliance.review@medicareaustralia.gov.au
Alternatively you can mail your feedback to:
Mail Compliance Complaints and Internal Review Section
Department of Human Services – Medicare
GPO Box 9822
Perth WA 6848
For more information
If you need more information about the changes to legislation please email compliance.legislation@humanservices.gov.au
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Last updated: 14 February, 2012