Changes to Medicare – Shared Debt Recovery Scheme

These changes relate to most Medical Practitioners and come into effect on 1 July this year (2019).

Do you know what is being billed on your provider number?

The Shared Debt Recovery Scheme (the Scheme) applies when the Department of Health (the Department) conducts post-payment Medicare compliance audits. The Scheme allows the Department to hold an employing or contracting organisation responsible for a portion of any debts incurred as a result of incorrect Medicare claiming, i.e. not only the Practitioner who ‘owns’ the provider number.

The Scheme will only apply to audits commenced from 1 July 2019 for services provided from 1 July 2018 onwards.

This change recognises that there has been an increase in the role of practices, corporate entities and hospitals in the billing of MBS services on behalf of individual practitioners. It also highlights that both parties have a responsibility to ensure MBS claims are made correctly, in that:

• Medical Practitioners have a responsibility to ensure claims made under their provider number meet the MBS requirements; and

• Medical practices have a responsibility to ensure that Medical Practitioners within a practice are claiming MBS items correctly.

When does the Scheme apply?

The following three criteria must apply:

• There is a recoverable amount (a debt) as a result of the making of a false or misleading statement;

• There is a relationship between the primary (practitioner) and secondary (organisation) debtor; and

• The secondary debtor could have controlled or influenced the making of the false or misleading statement, obtained a direct or indirect financial benefit from the making of the false or misleading statement, and/or there are other factors that make it fair and reasonable for a shared debt determination to be made.

The default percentage that may be applied to the primary debtor is 65 per cent and secondary debtor is 35 per cent.

It does not apply to all repayment scenarios e.g. debts arising as a result of inappropriate practice following referral to the Professional Services Review.

Further information is available in the Department's factsheet and FAQs.

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This blog contains general information only. We recommend you contact your medical defence organisation or insurer when you require specific advice in relation to medico-legal matters.