The audit will assess the effectiveness of the Department of Health and Aged Care’s (Health’s) approach to health provider compliance, including its response to the 2023 Independent Review of Medicare Integrity and Compliance. The audit will also examine the Professional Services Review Scheme, which investigates Medicare-referred cases of possible inappropriate practice in relation to Medicare, 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, the department 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 the department’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 Independent Review of Medicare Integrity and Compliance (the Philip Review), completed in March 2023, made a number of recommendations 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 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.