Assessment Services 008-06000000

Treating Health Professionals (THP) may sign off on reports where the customer completed all or some of the details. This does not constitute fraudulent medical evidence.

Assessors who suspect that the medical evidence may not be authentic, must:

• contact the Treating Health Professional (THP) listed on the medical evidence in question to confirm details provided
• not send or otherwise provide the medical evidence to the THP, including where the THP requests a copy of the evidence

If contact with the THP was unsuccessful, go to Step 3.

If during THP contact, the THP advises they did:

• author the specific medical evidence, procedure ends here
• not author the specific medical evidence, treat the evidence as not authentic
  • Do not use the evidence to inform the assessment
  • Complete an Additional medical Evidence for Disability Support Pension Record (SA463) to detail the conversation and scan or upload it to the customer's record
  • Go to Step 2

Assessors

Where the THP confirms they did not complete the medical evidence, Assessors must not use that evidence to inform the assessment.

Assessors must complete the following:

• Within the Assessment (MAt/JCA/ESAt):
  • Record the relevant medical condition/s as 'unverified'
  • Do not use the terms 'fraud' or 'fraudulent' in the assessment report
  • Include a statement in the assessment summary/recommendation rationale that records the THP's name, the date of contact, the type and date of the medical evidence discussed, and that the THP advised they did not author the evidence. For example:
    'THP [name] was contacted on [date] to discuss [type of medical evidence] dated [date]. The THP advised they did not author the evidence. On this basis, the relevant condition/s have been recorded as unverified.'
• In Work Optimiser/Workforce Australia Online for Providers (WAOP):
  • Place the assessment on hold
• In Process Direct:
  • Annotate the relevant referral DOC with the following:
    'Assessment on hold pending specialist advice'
• Go to Step 3

Assessment Services Customer Support Team (ASCST) service officers

ASCST service officer must annotate the DSP Claim DOC and/or Referral Request Fast Note with:

• the THP's name
• the date the THP was contacted
• the type and date of the medical evidence discussed
• a brief statement confirming the THP advised they did not author the medical evidence. Note: do not use the terms 'fraud' or 'fraudulent' in the statement

Refer all suspected and confirmed medical evidence to the relevant team below for review before completing the assessment:

For:

• medical evidence from a Psychologist or Psychiatrist, email the Forensic Psychology Team using Subject: Medical evidence of concern from Psychologist or Psychiatrist
• all other medical evidence, email Branch Correspondence Coordination using Subject: Medical evidence of concern

Go to Step 4.

Assistant Director or Director must review the referral form before submission.

• Complete a report of suspected fraud
• Include in the referral:
  • a summary detailing the medical evidence issue/s
  • record of conversation with THP as detailed on the SA463 form

Scanned copies or original medical documents are to be maintained by the Assessor.