Health Provider Compliance Strategy and 2025 compliance priorities

Members of the PCHD recently met with the Department of Health, Disability and Ageing Benefits Integrity Division to discuss Medicare compliance in the paediatrics sector.

The Department has recently published the Health Provider Compliance Strategy 2025-2030 which outlines the risk-based and proportionate approach to compliance, with a strong emphasis on prevention and education, and where enforcement action is taken based on the seriousness and scale of the identified behaviour. Compliance priorities for calendar year 2025 have also been published alongside the Strategy, reflecting the Department’s commitment to act in specific areas. The Department will continue to monitor claiming and the broader environment, meaning compliance priorities may evolve in response to emerging risks.

You can view the Strategy and 2025 compliance priorities by visiting health.gov.au and searching ‘Medicare compliance approach’ or by viewing the Our Medicare compliance approach | Australian Government Department of Health, Disability and Ageing. 

The Department has also developed the Understanding Medicare: Provider Handbook. This resource is a plain English guide that details the fundamental elements and principles of Medicare. It provides core guidance for healthcare professionals and others navigating the Medicare system. You can view the Handbook on the department’s website by visiting health.gov.au and searching ‘Provider Handbook’ or by viewing the Understanding Medicare: Provider Handbook (PDF).

The Department also provides a range of educational resources and support to help you meet your legal obligations as a health practitioner and reduce the risk of incorrect billing under Medicare. Learn more by visiting www.health.gov.au and searching ‘How to comply’ or by visiting How to comply with Medicare obligations | Australian Government Department of Health, Disability and Ageing.