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DoHDA reveals 2026 compliance watchlist
This year’s compliance priorities include a crackdown on telehealth, claiming MBS services while overseas, and care and management plans.
DoHDA will be focussing on five compliance areas in 2026, with telehealth at the top of its list.
Extra scrutiny will be placed on telehealth platforms in 2026, with the Department of Health, Disability and Ageing (DoHDA) releasing its latest Medicare compliance watchlist.
Released this week, the Health Provider Compliance Priorities reveal exactly what activities DoHDA will be cracking down on in 2026, with five areas flagged:
- Telehealth
- Care and management plans
- Claiming Medicare Benefits Schedule (MBS) services while overseas
- Open and uncertified Pharmaceutical Benefits Scheme (PBS) claims
- Inappropriate claiming of PBS medicines
It has also named several ‘enduring priorities’ that ‘present a persistent risk’:
- Preventing fraud
- Access to affordable healthcare
- Safeguarding high-quality and medically necessary services
- Medicare, public hospital and health services sustainability
Acknowledging the vital role of telehealth in maintaining continuity of care and improving timely access to medical services, DoHDA said its priority is to ensure providers understand how to claim correctly to ensure future growth is sustainable.
‘This includes a focus on MBS servicing and requesting, and PBS prescribing, from on-demand telehealth platforms,’ it wrote.
‘The rise of these businesses raises concerns about opportunistic and/or inappropriate claiming of health program payments, as well as commercial incentives conflicting with clinical best practice, continuity of care and patient safety.’
The move comes after the Federal Government announced it will implement changes to ensure all
medicines-related information from online prescribers is made available to consumers and their healthcare providers through My Health Record.
RACGP President Dr Michael Wright said that telehealth is a great support for GPs who know their patients, but there has been a concerning rise in telehealth-only services which may not meet all their MBS criteria.
‘The main change this year is there’s going to be a particular focus on telehealth, and over the last couple of years we’ve seen concerns about some of the telehealth-only providers in particular, targeting particular treatments or particular patients,’ he told
newsGP.
‘This compliance focus will be about making sure the services that are being billed are necessary and are compliant with MBS criteria, as well as making sure that PBS indications are met as well.’
The Department will also direct extra attention to the use of care and management plans, ‘monitoring claiming of these items to better understand how we can support health provider compliance and ensure MBS sustainability’.
Dr Wright said Medicare fees for care plans are some of the highest that GPs use so it isn’t surprising that DoHDA is looking at these.
‘The good news is that changes to the General Practice Chronic Condition Management Plans criteria means it is a lot easier to comply with the administrative requirements of these,’ he said.
‘This is just a warning to GPs to make sure that they’re completing these and have evidence of them.’
Heavier monitoring will also take place on PBS prescribing, with an aim to ‘prevent patient harm and protect the sustainability of the PBS by addressing high-risk claiming practices’.
This will include monitoring claiming of high-cost medicines, acting on
discrepancies between pharmaceutical sponsor supplies to market and claims for PBS medicines, and routine early supply of PBS medicines.
Dr Wright said the PBS compliance priorities are about making sure that people are prescribed medications according to their PBS indications.
‘An obvious one is some of the weight-loss agents, which are PBS listed for diabetes but not for obesity,’ he said.
‘GP should make sure they’re prescribing these medications privately if they don’t meet the PBS indication.’
Overall, Dr Wright said these were ‘pretty sensible’ areas to focus on, and ones that most GPs should have no concern or trouble complying with.
‘Ultimately, taxpayer money is funding these services, so we do need to make sure that they’re used appropriately,’ he said.
The 2026 priorities are available on the
DoHDA website and are supported by the
Health Provider Compliance Strategy 2025–30.
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