DoHDA Sets 2026 Medicare and PBS Compliance Priorities
27 Mar 2026
Telehealth, care and management plans, and certain Medicare and PBS claims will receive extra attention to make sure services are delivered safely and correctly.
The main focus areas for this year are:
- Telehealth services
- Care and management plans
- Claiming MBS services while overseas
- Open or uncertified PBS claims
- Inappropriate PBS medicine claims
DoHDA will also continue to watch ongoing priorities such as preventing fraud, keeping healthcare affordable, maintaining quality medical care, and supporting Medicare and public hospitals.
Telehealth is an important part of care, but DoHDA wants providers to follow the rules for claiming MBS and PBS items, particularly for on-demand telehealth services.
RACGP President Dr Michael Wright said telehealth works best when GPs know their patients. “Some telehealth-only services have caused concerns about targeting certain treatments or patients,” he said. “This focus is to make sure claims are safe, necessary, and meet MBS and PBS rules.”
Care and management plans will be monitored more closely. Dr Wright said recent changes make it easier for GPs to meet the requirements if they keep accurate records.
Extra checks will also cover PBS prescriptions, especially high-cost medicines or cases where prescriptions don’t match PBS rules. “For example, some weight-loss medicines are approved for diabetes but not obesity. GPs should prescribe privately in those cases,” he said.
Dr Wright added that these checks are sensible and most GPs should not have any problems complying. “This ensures taxpayer-funded healthcare is used appropriately and safely.”
The full 2026 compliance priorities and the Health Provider Compliance Strategy 2025–2030 can be found on the DoHDA website.
https://www1.racgp.org.au/
Source: Department of Health, Disability and Ageing (DoHDA)