Program Review provides information, counselling and education about the appropriate use of the Medicare Benefits Schedule, the Schedule of Pharmaceutical Benefits and other programs administered by Medicare Australia.
Program Review works with the health industry to:
Ensure the correct benefits are claimed for properly rendered services
- prevent and detect fraud and inappropriate practice with respect to claiming of benefits
Program Review uses advanced information management technology to collect, research and analyse health information to prevent, detect and investigate fraud and inappropriate practice.
Program Review encourages appropriate behaviour through education, interview and practice profile review processes under the Professional Services Review Scheme, and compliance activities.
In meeting Medicare Australia’s objective to make sure payment of benefits is correctly made for services properly rendered, the Program Review function is responsible for preventing, detecting and investigating fraud and inappropriate practice.
Program Review applies a balance of education and compliance strategies to meet the requirements for the Health Insurance Act 1973, National Health Act 1953, and the Medicare Australia Act 1973.
The Department of Human Services Compliance Program is developed to inform health professionals, industry stakeholders and the wider community about our compliance approach and activities for the coming financial year.
With a focus on ensuring the right person receives the right payment at the right time, the program details our commitment to using an appropriate mix of learning, support, deterrence and enforcement to encourage high levels of voluntary compliance.
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Last updated: 13 August, 2013