B. Medicare Australia

Audit strategy overview

Medicare Australia is an Australian Government statutory agency within the Human Services portfolio with the objective of working ‘with its strategic policy partners and stakeholders to improve the health and wellbeing of Australians by delivering information and payment services’. Key programs for which Medicare Australia is responsible for delivering payments include Medicare, the Pharmaceutical Benefits Scheme, 30% Rebate on Private Health Insurance, and Aged Care. During 2008–09, Medicare Australia paid over $30 billion in payments across the various programs it delivers.

In recent years, the ANAO has undertaken a performance audit program that has progressively examined Medicare Australia’s administration of the various health program payments it delivers, including the Pharmaceutical Benefits Scheme and the Practice Incentives Program.

The future audit strategy will continue this program with a potential audit of aged care payments. The audit coverage will also be expanded to reflect the increasingly diverse responsibilities of the agency (for example the development of the Unique Healthcare Identifier (UHI) Service), and cover some of the relatively smaller programs, such as rural and remote incentives, that are delivered by Medicare Australia.

Audits in progress at 1 July 2010

Practice Incentives Program

The Practice Incentives Program (PIP) aims to recognise and provide financial incentives to General Practices that provide comprehensive quality care and that are either accredited or working towards meeting the Royal Australian College of General Practitioners Standards for General Practices. Some $298 million was paid to General Practices and GPs under PIP in 2008–09.

Responsibility for program delivery is shared; DoHA is responsible for program policy development, including eligibility criteria, and Medicare Australia is responsible for assessing all applications from General Practices for participation in the program.

The audit is assessing DoHA’s effectiveness in undertaking PIP program planning, program monitoring and review; and with Medicare Australia, in ensuring PIP program delivery to General Practices and their medical practitioners.

The audit report is expected to be tabled in the Spring 2010 Parliamentary Sittings.

Potential audits

Administration of Aged Care Payments

In October 2005, Medicare Australia began managing aged care benefit payments on behalf of the Department of Health and Ageing (DoHA). Medicare Australia makes payments to approved aged care providers to help them provide quality, cost-effective care for frail, older people and support for their carers. In 2008–09 Medicare Australia processed 53 248 aged care claims making up $7.3 billion in aged care benefits.

An audit would continue the ANAO’s review of the various payments Medicare Australia delivers by examining its administration of aged care benefit payments.

Medicare Safety Net

The Medicare Safety Net was introduced in 2004 and is designed to protect Australians and their families from high medical costs for out-of-hospital medical services. The Safety Net provides thresholds, depending upon the person or family circumstance, that if reached will result in Medicare paying between 80 per cent and 100 per cent of the out-of-pocket or gap expenses. In 2008–09, the cost of the Medicare Safety Net was approximately $460 million.

An audit would examine Medicare Australia’s administration of the Medicare Safety Net including the processes in place to ensure eligible people are registered.

Rural and Remote Programs

Attracting and retaining medical practitioners in rural and remote areas has been a significant challenge for health administrators in recent times. Medicare Australia administers over
$50 million annually for a number of rural and remote programs aimed at encouraging medical practitioners to retain their services in these areas; increase the number of rural practitioners; and provide training to practitioners in delivering health services to rural and remote areas.

An audit would examine the effectiveness of the various rural and remote program payments administered by Medicare Australia.

Medicare Australia’s Role in the Development of the Unique Healthcare Identifier (UHI) Service

The provision of modern health care requires a greater sharing of health information between practitioners. The Unique Healthcare Identifier (UHI) will identify patients, practitioners and organisations involved in health care across Australia, and provide assurance regarding the identity of health records being communicated electronically. In December 2007, the National
E-Health Transition Authority (NEHTA) signed a two-year, $51.6 million contract with Medicare Australia to design, build and test the UHI Service, which was to be delivered in December 2009.

An audit would examine Medicare Australia’s role in the development and delivery of the UHI Service, including the management of the contract with NEHTA.

The Australian Organ Donor Register

The Australian Organ Donor Register provides a service for people wishing to consent or object to becoming organ or tissue donors. People register their consent or objection through a website, or through completing forms provided by Medicare Australia. The register is administered by Medicare Australia and, in the event of someone’s death, can be accessed by authorised personnel at any time, anywhere in Australia, to identify the deceased’s organ donor status. In 2008–09 more than 1.2 million people had registered their consent to organ or tissue donation.

An audit would examine the effectiveness of Medicare Australia’s administration of the register.

Compensation Recovery Program

The Compensation Recovery program aims to prevent ‘double dipping’ in benefits and subsidies paid by the Australian Government in relation to an injury or illness, where a person receives compensation in excess of $5000 for the injury or illness by way of a judgment or settlement. Medicare Australia administers the program on behalf of DoHA and in 2008–09, 45 057 cases were finalised with $33.2 million being recovered.

An audit would examine Medicare Australia’s administration of the Compensation Recovery program.

Capturing and Managing Customer Service Feedback

The Human Services portfolio is designed to improve the provision of social and health-related services for customers. An important part of a service delivery function is the ability to capture and respond to customer feedback. Obtaining customer and provider feedback gives an agency the opportunity to gather perceptions, expectations and experiences of service delivery and identify areas for improvement.

An audit would examine the management of customer feedback within the Human Services portfolio and could comprise either a whole-of-portfolio audit or a series of audits relating to individual agencies and/or programs.

 

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