Improved Medicare Compliance and Other Measures 2018


This training brochure applies to all organisations with obligations under the Health Insurance Act 1973 (Cth).

Health Legislation Amendment (Improved Medicare Compliance and Other Measures) Act 2018 No. 64 (Cth)

The Health Legislation Amendment (Improved Medicare Compliance and Other Measures) Act 2018 No. 64 (Cth) (the Amending Act) has amended the Health Insurance Act 1973 (Cth) (the Act).

Schedules 2 – 5 of the Amending Act commenced on 1 July 2018.

The most notable changes made to the Act are as follows:

  • Documents created in relation to the rendering of a professional service that is an item specified in the general medical services table, in which a claim is made for an amount under the Act, must be kept for a period of 2 years.
  • Referrals under sections 20BA, 23DK(1) and (2), 23DR(1) and 23DS(3) must now be kept for 2 years instead of 18 months.
  • A new section 20BB (confirmation of other referrals) has been inserted into the Act. The provision requires referrals in relation to a service that is taken to be a professional service because of a determination under the Act, where a claim for an amount in respect of the service has been made, to be kept for 2 years.  Failure to do so may result in a fine of 5 penalty units.
  • A new section 129AADA (requirement to keep documents relating to notice to produce) has been inserted into the Act. This provision requires any person who has been given a notice or a request by the Chief Executive Medicare to keep any document relevant to whether an amount should have been paid under the Act in respect of the service until the time set out in section 129AADA(2)(b).  Failure to do so may result in a fine of 20 penalty units for an individual, and 100 penalty units for a body corporate.

Conclusion

Organisations should update their policies and processes in line with the changes highlighted above and included in the NATIONAL – Medicare (General), NATIONAL – Medicare (Pathology) and NATIONAL – Medicare (Diagnostic Imaging and Radiation Oncology) modules.

Contact

For further information please contact the Law Compliance team:

Phone: 1300 862 667

Email: info@lawcompliance.com.au