A performance audit of the Department of Health’s success in dealing with fraud and non-compliance in its public health funding schemes has found the Department to be “partially effective”.
In his report Managing Health Provider Compliance, Auditor-General Grant Hehir assessed the effectiveness of the Department’s approach to its health provider programs which included the Medicare Benefits Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS).
“The Health Benefit Compliance program aims to support the integrity of Australia’s publicly subsidised health funding schemes by identifying and treating incorrect claiming, inappropriate practice and fraud by health providers,” Mr Hehir said.
“Given the large volume and value of health care providers’ claims, it is important to assess whether Health has an effective approach to the prevention, identification and treatment of incorrect claiming, inappropriate practice and fraud by health care providers and suppliers.’
Mr Hehir said his audit revealed that in the period examined, Health’s approaches to identifying, prioritising and treating non-compliance were partially appropriate.
“The absence of a risk-based approach in identifying and prioritising which compliance projects were selected for operational activity limited the effectiveness of the approach,” Mr Hehir said.
“Health’s oversight arrangements for monitoring health provider compliance outcomes were partially appropriate.”
He said that while the Department undertook internal monitoring and reporting of the health provider compliance case, outcomes by treatment type, external program performance measurement and reporting “was not based on a robust methodology.”
The Auditor-General made two recommendations, both of which were agreed by the Department
His online report can be accessed at this PS News link and his 46-page printed report at this link.
The audit team was Julian Mallett, Christine Preston, Anne Kent, Erica Sekendy, Samuel Painting, Brendan Gaudry, David Brunoro and Peta Martyn.
