Medicare and Health Insurance Shared Debt Recovery Scheme

As of July 1, 2019 medical health practitioners are able make a request for a shared debt determination when they are first contacted by Medicare. At Tego Insurance, we are experts in Medical Indemnity, Medical Practice Insurance and Medical Malpractice Insurance in Australia. Medicare is an important part of your business.

What is the Medicare Shared Debt Recover Scheme?

The Medicare shared debt determination is made when the practitioner is able to provide documentation that demonstrates that they do not receive 100% of the Medicare benefits. The practitioner will be asked to identify the second party (usually the principal practice) who receives the remainder of the Medicare benefits claimed under their provider number.

The identified secondary debtor will then be asked by Medicare for information in relation to any possible shared debt. This will include providing documents and submissions as to whether the identified secondary debtor should share liability with the practitioner.

Medical Indemnity Private Practice

For the shared debt scheme to apply there needs to be evidence that the secondary debtor has employed or engaged the services of the health practitioner which attracts a benefit under the Medicare Benefit Scheme/Pharmaceutical Benefits Scheme.

The legislation stipulates a default shared debt percentage of 35%. However, the review officer, on behalf of the Chief Executive Medicare, may vary the shared debt percentage depending on what they determine to be fair and reasonable.

When determining if a shared debt determination should be made, Medicare will consider whether:

  • The identified secondary debtor has control or influence over the submitting of the incorrect claims;
  • The identified secondary debtor has obtained any financial benefit from the claims; and
  • There are any other circumstances which would make it fair and reasonable for the determination to occur.

Tego Insurance is a Medical Indemnity Insurance provider and wants you to know about Medicare’s shared debt recovery scheme

Medicare may impose an administrative penalty on repayments for incorrect billing which will be payable by both debtors.

Medicare can also offset or deduct repayments from other amounts owed by Medicare to the debtors. Alternatively, Medicare may issue a garnishee notice.

Both debtors are entitled to have the shared debt determinations reviewed which must be lodged within 28 days of the decision.

In Conclusion

The Tego Insurance team specialises in Medicare and all health care business. If you would like advice about the intricacies of dealing with  Medicare, please contact us! Tego Insurance offers Medical Medical Malpractice Insurance as well as GP Medical Insurance for Healthcare practitioners. We have a profound understanding of the Australian medical profession and the ever-changing healthcare industry. It’s this expertise that allows us to provide leading cover with more choice, innovation and greater flexibility. 

This publication is general in nature and is not comprehensive or constitute legal or medical advice. You should seek legal, medical or other professional advice before relying on any content, and practice proper clinical decision making with regard to individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgment or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Tego Insurance Pty Ltd is not responsible to you or anyone else for any loss su­ffered in connection with the use of this information.