Debt recovery for Medicare programmes 107-21042124

The Medicare Debt Recovery team pursues the recovery of debts for the following:

• Medicare Benefits Schedule (MBS) benefits
• Pharmaceutical Benefits Scheme (PBS)
• Aged Care
• Continence Aids Payment Scheme (CAPS)
• Incentive Programs
• External Breast Prostheses Reimbursement Program (EBPRP)
• Australian Immunisation Register (AIR)
• Department of Veterans' Affairs
• Medicare Compensation
• Public Compliance debts for all Medicare programs

Where a Medicare benefit is paid in excess of the prescribed fee, a debt can occur.

Debt can result from incorrect claiming by:

• Medical providers
• Health funds
• Pharmacists
• Medical Practices
• Allied Health providers
• members of the public

They can also result from processing errors by Services Australia.

The PBS is a program that subsidises prescription medication for:

• Australian citizens
• permanent residents, and
• international visitors covered by a reciprocal health care agreement

The PBS is separate to the Medicare Benefits Schedule.

A debt occurs where a customer receives a benefit they are not eligible for.

Approved aged care providers receive subsidies and supplements to provide care to eligible recipients.

A debt occurs where a provider receives a subsidy or supplement they are not eligible for.

CAPS is an Australian Government Scheme that provides a payment to people who have permanent and severe incontinence. A debt occurs where a customer receives a benefit they are not eligible for.

Incentive Programs include:

• Practice Incentives Program (PIP)
• Workforce Incentive Program (WIP) - Practice Stream
• General Practitioner Rural Incentive Program (GPRIP)
• Rural Procedural Grant Program (RPGP)
• Health Care Homes (HCH)
• Aged Care Education and Training Incentive Programme (ACETI)

A debt occurs because of an overpayment to a customer.

The program assists with the cost of an external breast prosthesis after breast cancer surgery. It provides reimbursement towards the cost of new or replacement prostheses, up to the amount of $400 for each breast. See External Breast Prostheses Reimbursement Program (EBPRP).

The AIR records vaccines given to people in Australia.

Medicare Recovery recovers debts created due to overpayment of benefits to Immunisation Program providers.

The Department of Veterans' Affairs (DVA) provides funding to eligible people for:

• medical
• hospital, and
• allied services

Debts may occur due to overpayment of benefits.

Some compensation payments are subject to reimbursement to Medicare. This is only for eligible benefits.

The Medicare Compensation Team identify insurer and claimant debts through an outstanding valid NOC (Notice of Charge). Where the NOC payment is not received within 28 days, the Medicare Compensation team refer these debts to Medicare Recovery. See Compensation debt recovery for Medicare.

Fraud against Service Australia’s health programs can happen when a patient / customer:

• makes a claim for Medicare services they did not receive
• uses someone else's Medicare card
• uses an invalid concession card
• forges prescriptions for Pharmaceutical Benefits Scheme (PBS) medicine
• obtains prescriptions unlawfully
• takes or sends PBS medicine overseas that is not for them or someone they are travelling with

Any unpaid debts are referred to Medicare Recovery for action.