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The RACGP met with the Department of Health, Disability and Ageing (DoHDA)’s Benefits Integrity Division on 25 May, and we’ve also spoken with the Medicare Benefits and Digital Health Division about upcoming assignment of benefit changes.
Assignment of benefit update
Changes to the assignment of benefit process for bulk-billed Medicare Benefits Schedule (MBS) services will commence on 1 July, providing a range of digital options for patients to assign their rebate to their GP as full payment for a bulk-billed service.
The RACGP is aware of member concerns about the consent process for patients unable to assign their benefit, particularly those in residential aged care facilities. We continue to lobby the government for a practical solution for aged care patients and keep members updated on our advocacy.
DoHDA has recently published a set of frequently asked questions to help clarify the changes to Medicare processes and guide you on how best to prepare. As with any significant reform, DoHDA is committed to ensuring GPs are well-informed about the new requirements. An early focus will be on education and provider support, with an emphasis on understanding where practitioners currently stand regarding these changes and encouraging greater awareness of the updated claiming requirements. Making sure practitioners are fully aware and understand these reforms is absolutely vital, as it supports DoHDA’s ongoing risk and intelligence-based compliance efforts.
2026 health provider compliance priorities published
DoHDA has outlined key areas where it will focus compliance efforts over the coming year. The 2026 priorities are available on the DoHDA website and are supported by the Health Provider Compliance Strategy 2025–30.
Federal Budget 2026
This year’s budget included $146.8 million over four years towards strengthening up-front controls to reduce the payment of incorrect or fraudulent MBS claims, enhanced fraud detection and disruption, and significantly increasing Pharmaceutical Benefits Scheme (PBS) compliance activity.
The savings from a reduction in fraud and non-compliance are expected to be around $670 million over four years.
The savings will not come from an increase in post-payment MBS compliance activities on practitioners, but rather through reduction in fraud and improved PBS compliance activities. All valid claims will continue to be paid.
PBS compliance
Ensuring prescriber and pharmacy sector compliance with PBS requirements is a current area of focus for DoHDA. Risks identified include:
- prescribing outside PBS listing restrictions
- prescribers writing private prescriptions that include PBS item or authority approval codes, which may result in pharmacies incorrectly claiming PBS supplies for ineligible prescriptions/patients
- prescribers writing prescriptions for patients they have not consulted, which may indicate limited clinical relevance for the prescribing.
Prescriber bag concerns relate to prescribers receiving supplies from more than one pharmacy in the same month, receiving supplies exceeding the maximum allowable PBS quantity, and routinely ordering high levels of supplies. Prescriber bag supplies are intended to enable individual prescribers to supply certain medicines directly to their patients in emergencies and should not be used by other providers. While most pharmacies and prescribers appear compliant, DoHDA is considering what education might be beneficial in this space.
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