Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2025

Strategic Insights -

The Australian Government has introduced the Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2025, aimed at strengthening Medicare and protecting its integrity. The bill proposes several measures to improve the compliance framework of Medicare, including reducing the timeframe for making Medicare claims from two years to one year, and enhancing investigative powers to address serious noncompliance and fraud. The bill also seeks to streamline the process of approving the supply of pharmaceutical benefits, improve the recovery of incorrect payments, and protect patient safety by removing restrictions on the admission of information obtained under the Professional Services Review's 'notice to produce' powers as evidence in relevant proceedings.

Key Takeaways:

  • The bill introduces several measures to improve Medicare's compliance framework, including reducing the timeframe for making Medicare claims from two years to one year, and enhancing investigative powers to address serious noncompliance and fraud.
  • The bill streamlines the process of approving the supply of pharmaceutical benefits by condensing the two-stage process into a single-stage process of up to four months.
  • The amendments improve existing powers to obtain information about potential fraud and noncompliance and enable the recovery of amounts if they should not have been paid.
  • The bill removes restrictions on the admission of information obtained under the Professional Services Review's 'notice to produce' powers as evidence in relevant proceedings, including proceedings for the purposes of the national law for the health practitioner registration and accreditation scheme.
  • The existing restrictions on the admission of information obtained under the Professional Services Review Agency's 'notice to produce' powers as evidence in proceedings, including proceedings under the Health Practitioner Regulation National Law, will no longer apply.
  • The bill enhances the capacity of the government to manage and alleviate the consequences of therapeutic goods shortages in Australia by allowing the secretary of the department to approve the importation or supply of substitutable unapproved products from overseas.
  • The bill adapts to emerging public health threats by lowering the threshold that must be satisfied before the secretary may give an enforceable direction to a person under section 42YT of the Therapeutic Goods Act.
  • The bill provides minor amendments to the Therapeutic Goods Act and the Public Health (Tobacco and Other Products) Act 2023 to keep the acts up to date and assist with the TGA's important functions.

Statistics:

  • The bill reduces the timeframe for making Medicare claims from two years to one year, which is expected to improve payment integrity and reduce the number of incorrect and fraudulently submitted claims.
  • The streamlining of the process of approving the supply of pharmaceutical benefits is expected to reduce a significant administrative burden and provide more timely access to pharmaceutical benefits.
  • The bill improves the recovery of incorrect payments, enabling the recovery of amounts if they should not have been paid.
  • The bill removes restrictions on the admission of information obtained under the Professional Services Review's 'notice to produce' powers as evidence in relevant proceedings.

Sources:

  • Explanatory Memorandum for the Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2025
  • The Australian Government's website
  • The Philip Review of Medicare Integrity and Compliance, undertaken by Dr Pradeep Philip
  • The Health Insurance Amendment (Professional Services Review Scheme) Act 2023 and the Health Insurance Amendment (Professional Services Review Scheme No. 2) Act 2023
  • The Therapeutic Goods Act 1989
  • The Public Health (Tobacco and Other Products) Act 2023