A 2020 Australian National Audit Office report estimated the value of Medicare non-compliance at between $366 million and $2.2 billion a year.

In November 2022, the Albanese Government appointed respected health economist, Dr Pradeep Philip, to conduct an independent review into the integrity of Medicare and its compliance mechanisms. 

As the Lead Partner at Deloitte Access Economics, and a former Secretary of the Victorian Department of Health and Human Services, Dr Philip has a long history working at the highest levels of public policy in Australia.

The independent review assessed the possible value of fraudulent, non-compliant or over servicing risks in Medicare, and provided a methodology and evidence-based estimate of the likely value of non-compliance in Medicare.

More than 500 million Medicare services are delivered each year totalling around $32 billion in government spending. After nine years of cuts and neglect, the review comes at a time of great pressure on the health system in Australia. A key finding from the review was that the overwhelming majority of practitioners are well meaning and protective of the Australian health system, particularly of the care they provide to their patients.

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These are significant forces at work in the health system – its evolution not matched by the policy and legislative underpinnings of the payment system. Moreover, the current system is overly fragmented, disjointed, and lacking in contemporary tools to detect and address non-compliance and fraud, despite the best endeavours of bureaucrats, regulators, and peak bodies.