The Department of Health, Disability and Ageing has asked AAPi to share the following information with members.
The Health Provider Compliance Priorities 2026 outline key areas where the Department of Health, Disability and Ageing (the department) will focus compliance efforts over the coming year and reflect a commitment to act and protect Medicare integrity. These priorities encompass the department's responsibilities for compliance across Australian Government health program payments, including the Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS), Child Dental Benefits Schedule, and the Practice Incentive Program.
The below priority areas are likely to be most relevant to psychologists:
Telehealth
Telehealth plays an important role in supporting continuity of care and improving access to timely health services, particularly for patients who face geographic, mobility, and/or scheduling barriers. Our focus is on ensuring providers understand MBS claiming requirements so that telehealth services remain safe, effective and sustainable into the future. This includes appropriate use of MBS telehealth items when care is delivered via on-demand telehealth platforms. The growth of these platforms has raised concerns about opportunistic or inappropriate claiming practices, as well as commercial incentives that may conflict with clinical best practice, continuity of care and patient safety.
Care and management plans
Care and management plans support comprehensive and coordinated care for patients with chronic and complex conditions by facilitating structured, multidisciplinary input. We are monitoring claiming of care planning items to better understand usage patterns and identify opportunities to support provider compliance, while ensuring the long‑term sustainability of the MBS.
Claiming MBS services while overseas
Medicare benefits are only payable where a service is delivered and supervised within Australia to an eligible patient. Claims for services performed or supervised from overseas, including via telehealth, do not meet these requirements and compromise Medicare integrity.
In 2025 and early 2026, we undertook extensive engagement, education and enforcement activities with GPs and specialists. In 2026, we will continue to monitor GP and specialist servicing, and begin analysis and engagement with the allied health and dental sectors.
Our focus remains on helping providers understand and meet their obligations, to maintain the integrity and sustainability of the MBS.
Preventing fraud
Medicare fraud involves obtaining benefits or payments illegally through dishonest or unauthorised practices. This can include billing for services that were not provided. Our efforts are focused on disrupting concerning behaviour and strengthening preventative controls to protect the integrity of Medicare.
Access to affordable healthcare
The Australian Government continues to invest significantly in bulk billing to support patient access to affordable health care. When a provider chooses to bulk bill a service, they accept the Medicare benefit as full payment for that service. Patients must not be charged any additional out-of-pocket costs such as co-payments, gap fees, or membership charges for bulk billed services.
Safeguarding high-quality and medically necessary services
Some services offer limited or no clinical benefit to patients while adding unnecessary costs to Medicare. This can expose patients to harm and divert healthcare resources away from effective care.
Our focus includes action on:
- providers engaging in inappropriate practice, where some or all services constitute a prescribed pattern of service
- third‑party delivery or corporatisation of health services service where revenue may be prioritised over clinically relevant care.