Minister for the National Disability Insurance Scheme
Minister for Government Services

Media release: Medicare fraud detection program pays dividends

13 July 2019

The Hon Stuart Robert MP

Minister for the National Disability Insurance Scheme
Minister for Government Services

A new sophisticated Medicare fraud detection program incorporating advanced fraud risk and data analytics capabilities is already yielding strong results.

Minister for Government Services, Stuart Robert, said since the program was introduced in late 2018, it has already prevented $370,000 in fraudulent Medicare claims being paid to members of the public.

“Significantly, the number of Medicare investigations the Department of Human Services referred to the Commonwealth Director of Public Prosecutions (CDPP) more than doubled last financial year, Minister Robert said.

“Overall, in relation to Medicare public claiming, the department completed close to 260 investigations in the 2018-19 financial year and raised over $730,000 in debts.

“Intelligence analysts have access to a suite of tools, such as geospatial mapping and statistical and financial insights, which help to support the identification of anomalies in Medicare claiming.

“The Morrison Government takes intentional fraud and the protection of our Medicare system very seriously. Where investigations reveal sufficient evidence of criminal behaviour people will be referred to the CDPP—even if they didn’t get the money they were attempting to fraudulently obtain.”

The department has already referred 14 matters to the CDPP where fraudulent claims were detected before they could be paid out to the individual. One of these individuals has already been convicted after trying to claim around $5,000 through the Express Plus Medicare app.

In another case referred to the CDPP, it was found that an individual had claimed almost $75,000 in Medicare rebates to which they were not entitled. In May this year, they were convicted and sentenced to two and a half years imprisonment and a three-year good behaviour bond.

Page last updated: 15 July 2019