Medicare/Private Health Insurance audits and investigations

Meridian Lawyers assists health practitioners holding provider numbers to respond to compliance activity conducted by Commonwealth agencies such as the Department of Health and Aging, concerning the billing of PBS and MBS items. We are highly skilled in guiding and assisting practitioners when the compliance activity escalates to a referral to the Professional Services Review. We offer expert advice on negotiating a section 92 agreement or when proceeding to committee hearings.

Our team also assists health practitioners during audits and investigations by private health insurers. This often includes advising about privacy (right of private insurer to access patient records), the adequacy of records, the interplay of HICAPS, and derecognition processes by the private insurers. We also provide strong support with submissions and dispute resolution.

Key services

Advising on compliance activity by Commonwealth agencies concerning the billing or initiation of services that attract a Medicare or PBS rebate
Advising on the Commonwealth Voluntary Acknowledgement of Incorrect Claims process and the Shared Debt Recovery Scheme
Representing practitioners before the Professional Services Review and negotiating outcomes
Advising on private health insurer audits and investigations and negotiating outcomes