Submission to the Australian National Audit Office – Managing health provider compliance audit


Date: December 2019

The RACGP has provided a submission to the Australian National Audit Office’s Managing health provider compliance audit.

The objective of this audit is to assess the effectiveness of the Department of Health’s approach to health provider compliance.

In summary, the RACGP submission highlights:

  • that Medicare Benefits Schedule (MBS) item descriptors and requirements are overly prescriptive and focus on administrative processes as opposed to quality patient care
  • an increase in compliance activities targeting GPs
  • that the Department of Health has displayed a willingness to engage with the RACGP around compliance activities. However, its approach to compliance remains focussed on identifying billing outliers and recuperating funds rather than implementing educative and preventive measures
  • that many providers feel they have been unfairly targeted by the Department’s compliance activities, when in fact they have legitimate reasons for billing or prescribing a certain way
  • that providers don’t have confidence in the advice provided by government agencies, such as AskMBS, as they frequently report receiving unclear and contradictory advice
  • that a greater focus on compliance education and preventive measures is needed for all key stakeholders
  • that providers would also benefit from improved transparency regarding Professional Services Review processes.

Read the submission

Submission to the Australian National Audit Office (PDF 423 KB)