The audit will assess the effectiveness of the Department of Health, Disability and Ageing’s (Health) and Services Australia’s approach to health provider compliance, including their response to the 2023 Independent Review of Medicare Integrity and Compliance (the Philip Review). The audit will also examine the Professional Services Review Scheme, which investigates referred cases of possible inappropriate practice in relation to the Medicare Benefits Schedule, Child Dental Benefits Schedule (CDBS) and Pharmaceutical Benefits Scheme (PBS).

Health has policy responsibility for Medicare, the CDBS and the PBS. Through its Health Benefit Compliance Program, Health aims to support the integrity of health benefit claims through prevention, early identification and treatment of incorrect claiming, inappropriate practice and fraud. Auditor-General Report No. 17 2020–21 Managing Health Provider Compliance found that Health’s approach to health provider compliance was partially effective, due in part to a lack of risk-based compliance planning and monitoring of compliance outcomes. The Philip Review made a number of recommendations to Health and Services Australia to strengthen the integrity of the Medicare system and its health provider compliance mechanisms. In the 2023–24 Federal Budget, Health received $29.8 million to establish a taskforce to respond to the Philip Review’s recommendations. In the 2024–25 Budget, Health received $18.1 million over four years to extend and expand the government’s response to the Philip Review.