Medicare Reviews Recover Record $32.6 Million in Practitioner Repayments
04 Nov 2026
According to the PSR's latest annual report, the agency received 124 requests for reviews during the financial year, compared with its five-year average of 99.
The PSR investigates concerns about inappropriate Medicare billing. However, it does not start investigations itself. Cases are referred by the Chief Executive of Medicare, which operates under Services Australia.
The agency completed 111 reviews during the year. Most were resolved through Section 92 agreements, where practitioners acknowledge inappropriate practice and agree to repay money.
Only seven cases were closed without further action.
Other outcomes included partial Medicare Benefits Schedule (MBS) disqualification in 57 cases and full disqualification in one case. Reprimands were issued in 60 cases, while 67 practitioners received counselling.
The amount recovered was higher than the $31.6 million reported in 2023–24.
The report also found that 82% of active cases were less than 12 months old as at 30 June 2026. Only 5% had remained open for more than three years.
Reasons for longer investigations included Federal Court proceedings, practitioners leaving Australia and serious illnesses that affected their ability to take part in the review process.
Chronic disease management, health assessments and mental health services were among the most commonly reviewed areas. Prescriptions involving opioids, benzodiazepines and antibiotics also attracted attention.
The PSR reported an increase in reviews involving telehealth and telephone consultations, reflecting greater use of these services by medical practitioners.
Concerns included missing or incomplete clinical records that did not clearly show what care had been provided. The agency stressed that telehealth and telephone consultations must meet the same record-keeping standards as face-to-face appointments.
The report also identified three referrals involving suspected fraud. A further eight cases were referred to the Australian Health Practitioner Regulation Agency (AHPRA) for concerns about professional standards. Six of these also involved patient safety issues.
There were 28 review requests involving prescribed patterns of services, including 25 related to the 30/20 rule. This rule triggers an automatic referral when a practitioner provides 30 or more telehealth consultations in a day on at least 20 days within a year.
This was slightly lower than the 29 referrals recorded under the same rule in the previous financial year.
The PSR also reviewed services provided by GPs and other medical practitioners in residential aged care facilities (RACFs).
The agency acknowledged the importance of maintaining access to medical care in aged care homes and said this was considered when reviewing practitioners' work.
Medicare Reviews Recover Record $32.6 Million in Practitioner Repayments
Source: Professional Services Review (PSR) Annual Report 2025–26.