Payment recovery for Practice Incentives Program (PIP) and Workforce Incentive Program (WIP) - Practice Stream 012-10010100

Overpayments funds are debts owed to the Commonwealth of Australia.

All overpayments must be recovered in accordance with the Public Governance, Performance and Accountability Act 2013.

The Service Officer who identifies the overpayment will initiate the recovery action and Program Management (Payments team) will confirm the recovery amount.

A Recovery Officer in the Incentives Processing team finalises the recoveries process by quality checking and collating the recovery documents and sending them to Medicare Debt Recovery to recover the debt.

The Medicare Debt Recovery team manage the remainder of the process.

Consider all incentive payments when calculating the total amount to recover. This includes:

• PIP
• WIP - Practice Stream
• GP ACAI

Service Officers must send a separate letter for each program if the overpaid funds are for a mix of PIP, WIP - Practice Stream and/or GP ACAI payments, using the correct recovery letter template.

Do not consolidate recovery letters, even if the letters are for the same debtor.

When completing a recovery letter, check PIP and WIP Online for a change of ownership, and ensure the letter is addressed to the owner of the practice at the point-in-time date that the overpayment occurred. The previous practice owner must provide their forwarding address on the Practice Incentives Change of practice ownership (IP010) form.

See the Practice Incentives letters list for a list of recovery letters.

See also Forms and letters for PIP and WIP - Practice Stream

A voluntary reimbursement is when a debtor returns overpaid funds by cheque without having been notified of an overpayment by Services Australia.

A Recoveries Officer will initiate the recoveries process.

The Process page has the procedure.

Incentive payments are calculated using the information provided by the practice and Medicare and Department of Veterans’ Affairs (DVA) data at the point-in-time date.

A practice must tell Services Australia about changes to practice arrangements:

• within 7 days of the change, or
• at least 7 days before the point-in-time date

Delays in notifying Services Australia of changes to practice arrangements or practice eligibility can result in an overpayment.

Services Australia is required by law to recover all ineligible payments.

All overpaid funds need to be recovered if the practice fails to do this.

See also Payments for PIP and WIP - Practice Stream

The Department of Health and Aged Care (DoHAC) conducts audit and compliance activity for the PIP and WIP - Practice Stream.

In 2021, DoHAC undertook voluntary compliance activity and recovered funds for:

• PIP After Hours Incentive
• Procedural GP Payment, and
• WIP – Practice Stream

Before starting recovery action, the Recoveries Officer must email Program Management to seek confirmation that the debt has not already been pursued by DoHAC.

The Process page has the procedure. More information is on the Resources page.

Practice closure

A practice is not entitled to receive payments for the payment in which the practice closes.

Establish the date of the closure to see if an overpayment was made.

For example, if the practice closes in January and notifies Services Australia in June, the February and May payments must be recovered.

A practice will not be eligible to claim PIP Teaching Payments for teaching sessions that were provided by the practice in the same payment reference period that the practice is closed or withdrawn from the PIP.

Change of practice ownership

The previous owner/s are not entitled to receive payments after the date of sale notified on the IP010 form.

Services Australia will make payments to the bank account details held on record at the point-in-time date. If a delay in notifying Services Australia of a change of ownership results in a payment dispute, the matter must be resolved privately between the old and new owner.

If an internal administrative error results in a payment being made to the old owner, escalate the issue to Program Management.

Practice eligibility for payment

A practice is not entitled to receive payments if it does not meet the program or individual incentive eligibility criteria for the entire payment quarter.

A practice is not entitled to receive payment for individual incentives where the practice does not meet:

• the eligibility criteria, or
• the requirements of their nominated payment tier/level by the point-in-time date

Where practice circumstances have changed, the practice is obligated to withdraw, opt-out or amend their nominated payment tier/level prior to the point-in-time date to avoid overpayment.

Establish the date the eligibility criteria or payment requirements were no longer met to see if an overpayment was made.

For example, if a procedural GP left a practice in June and the practice receives a Procedural GP payment in August, the practice did not meet the eligibility criteria and the practice has received an overpayment. This is because the general practitioner (GP) ceased working at the practice during the payment reference period, and the practice failed to notify Services Australia prior to the point-in-time date.

Incorrect provider information

A practice can be overpaid or underpaid if a GP is registered incorrectly. For example:

• the incorrect provider number is registered
• the practice has provided a provider number that relates to a different practice

For example, a practitioner is registered a practice A and practice B. The provider uses the provider number for practice A while working at practice B,

Establish the dates and the payment quarters the GP worked at the practice to see if an overpayment was made and escalate to the Local Peer Support (LPS). Program Management will confirm the recovery amount.

GP ACAI

General Practitioner Aged Care Access Incentive (GP ACAI) payments are made to the bank account advised by the GP. It is up to the GP to ensure correct banking details are recorded in Provider Directory System (PDS) by the point-in-time date.

Services Australia will make payments to the bank account details held on record at the point-in-time date. If a delay in notifying Services Australia of a change of bank details results in a payment dispute, the matter must be resolved privately.

If an internal administrative error is made when recording bank account details, escalate to Program Management.

See also Payments for PIP and WIP - Practice Stream