Independent News For The Australian Public Service
Edition Number 408. Updated Tuesday, 06 May 2014

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Audit finds flaws in Medicare audits

An investigation into the audit process for medical practitioners claiming Medicare payments has found the Department of Human Services' (DHS) management to have "mixed" levels of effectiveness.

In his audit report, Medicare Compliance Audits, Auditor-General, Ian McPhee found that while DHS has worked to make health professionals more aware of their obligations, administration of the audit process to ensure they were compliant was lacking.

Medicare provided 344 million services in 2012-13 for the $18.6 billion in payments processed by the Department, which is responsible for administering Medicare.

Mr McPhee said the integrity of this high volume of payments relies in large part on health professionals correctly determining and billing against the Medicare Benefits Schedule (MBS) items that correspond with the services provided.

'Mixed' levels of effectiveness

"Human Services has delivered a program of compliance audits and related compliance activities, which has helped reinforce health professionals' awareness of their compliance obligations," Mr McPhee said.

But he said the overall effectiveness of management of Medicare compliance audits had been "mixed", including implementation of the Increased Medicare Compliance Audit (IMCA) Initiative, as announced in the 2008-09 Budget.

"The Department's administration of Medicare compliance audits and its implementation of the Budget measure, the IMCA initiative, demonstrated a range of shortcomings," he said.

The investigation found DHS relied on a mix of environmental scans, such as monitoring claiming patterns as well as tip‑offs, and stakeholder input and had "not routinely undertaken preliminary analysis of emerging risks in a timely way".

Mr McPhee also recommended the development of a new debt calculation policy to address inconsistencies and non‑compliance, after the review of a sample of Medicare compliance audits also identified inconsistent approaches within DHS to calculating debts.

The audit team was Emilia Schiavo, Christine Preston and Donna Burton.

The full report can be viewed at this PS News link.

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