While it’s been a few years now since midwives have been able to bill Medicare directly, the issue of Medicare’s Audit and Professional Services Review may not have been adequately on midwives’ radar.

Medicare’s position is that it has a legal obligation to recover money owed to the Australian Government if a Medicare benefit has been claimed incorrectly or payment has been made incorrectly.

Medicare can conduct compliance audits of all health professionals, who claim Medicare benefits, randomly, or if a suspicion is raised that payments or billings are incorrect. If Medicare finds a payment that appears incorrect or inappropriate, the practitioner is given the opportunity to respond and, if necessary, repay the incorrectly claimed benefit.

Medicare is quite clear: unless there is documentation to support the Item claimed, then it is very likely that Medicare will take the view that the service cannot be substantiated and therefore the midwife will be obliged to repay any benefits paid to the midwife.

It is also important to remember that the obligation is on the midwife to ensure that Medicare benefits have been appropriately claimed.  In many practices, the administrative aspects of billing are delegated to the administrative staff of a medical practice.  While there is no prohibition on this practice, Medicare is firmly of the view that it is the responsibility of the midwife to correctly claim the Medicare benefit irrespective of who performs the billing tasks.

Medicare has a wealth of information available to assist midwives in relation to its investigatory processes and substantiation of Medicare benefits claimed.  Please visit www.psr.gov.au/ 

If you receive a notification from Medicare that an investigation is to be carried out, contact us as soon as possible so that one of our solicitors can assist you with your response

Other resources

  1. Find out more

    Visit the Professional Services Review website for more information

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