Data Matching for Medicare Compliance Purposes

In order to better detect Medicare fraud and incorrect claiming the Department has data matching and sharing arrangements with other Commonwealth Agencies.

Page last updated: 02 March 2021

The National Health Act 1953 (National Health Act) enables the Department to undertake data-matching, in specific circumstances, for a permitted purpose.

The National Health Act provides authority for the Chief Executive Medicare (CEM) to match defined sets of data for permitted purposes, which relate to Medicare compliance. It also allows the CEM to authorise another Commonwealth entity to match data on the CEM’s behalf for a permitted purpose. This forms part of the CEM’s provider compliance functions exercised by the Department.  

The National Health Act requires the Minister for Health to make a legislative instrument in relation to the matching of data. This legislative instrument is called the National Health (Data-matching) Principles 2020 (Principles). It sets out governance requirements for data matching that help to provide transparency and accountability of data matching activities.

The Principles require:

  • A public Data Matching Program Notice to provide transparency and awareness of data matching,
  • A Public Register to be published to describe the kinds of information matched by the CEM, or authorised Commonwealth entity on behalf of the CEM.

Links to the Data Matching Program Notice and the Public Register are below.

Data Matching Program Notice (PDF 241 KB)
Data Matching Program Notice (Word 74 KB)

Public Register (PDF 542 KB)
Public Register (Word 22 KB)

The data matching arrangements do not expand the powers of the Department to conduct health provider compliance activities. Nor do they change the approach taken by the Department in conducting its compliance activities.

The purpose of data matching for Medicare compliance purposes is to improve the Department’s ability to match and share data to identify fraud and incorrect or inappropriate claiming. Data matching will not authorise the automation of compliance outcomes or raising of debts. It is an identification tool for the Department’s compliance officer’s to continue to follow prescribed and/or legislated compliance processes.

The Department complies with Australian Government security policies such as the Attorney-General Department’s Protective Security Policy Framework and the Department of Defence’s Information Security Manual. Data is transferred securely and may only be matched in secure environments. Data is subject to strict security controls, and can only be accessed by suitably authorised staff when required for their duties.

Data matching does not impose any changes or new obligations on health providers in relation to their Medicare billing requirements. Compliance education resources for health professionals are available online.

Further Information and Support:

National Health Act

National Health (Data-matching) Principles 2020

Health may be contacted about data matching for compliance purposes at MedicareProviderDataMatching@health.gov.au