Medicare cheats would face fine notices and faster bans
Doctors, dentists, chemists and test labs that bill Medicare would face new fines, longer record rules and faster bans. The government says it wants to stop wrong and false claims on public money.
Official name: Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2026
- The health department could send fine notices, like parking tickets, to doctors and others who break Medicare billing rules.
- Fines for false claims and for not warning patients about costs would go up a lot. Doctors would keep patient billing records for 5 years, not 2.
- The department could make people hand over papers, and win back medicine scheme money that was paid by mistake.
- The head of the health department could ban a doctor from Medicare for up to 5 years after a fraud conviction.
- A bill is a proposed law. This one was put to Parliament on 28 October 2026. It is not law yet.
Who it affects
- Doctors, specialists and dentists: You would keep billing records for 5 years, and you could get a fine notice for smaller rule breaks, such as not keeping records.
- Doctors charged with Medicare or dental fraud: The head of the health department could stop Medicare paying for your work while your case runs.
- Chemists and hospitals that hand out medicines the government pays toward: The department could make you hand over papers and pay back money you should not have got.
- Test labs and their doctors: Test labs give Medicare a written promise to follow its rules. If you break it, the department head could stop Medicare paying for your tests for up to 5 years.
- Patients: You must still be told before a visit if Medicare will not pay, and the fine for not telling you goes up.
- People with a medicine safety net card: You could apply online. If the department thinks you should not have a card, you would get a letter and 14 days to reply before it is cancelled.
Why it exists
Medicare is the public scheme that pays part or all of the cost of seeing a doctor. A second scheme, the medicine scheme, pays for most of the cost of many medicines. A third pays for dental care for some children. All three use public money.
Dr Pradeep Philip ran an outside review for the government. It looked at how Medicare checks for wrong and false claims. He found the health department had few ways to act on small or middle-sized rule breaks. Most of its checks relied on doctors choosing to fix things. It could not force them. For bigger cases it had to go straight to court.
Laws passed in 2023 and 2025 put some of his ideas into law. This bill would add more. A bill is a proposed law. This one comes from the Health Minister, Mark Butler. It changes three main laws. These cover Medicare, the medicine scheme and the child dental scheme.
Fine notices and promises
The first part of the bill gives the head of the health department new tools. These tools come from a standard national law. A watchdog is an agency that makes sure rules are followed. Other watchdogs already use these tools, such as the agency that checks medicines are safe.
One tool is a fine notice. It works a bit like a parking ticket. If you pay it, the matter ends and you do not go to court. The department could send one for smaller rule breaks, such as not keeping records.
Another tool is a written promise. A doctor or chemist could promise to fix a problem. If they break the promise, a court can make them keep it. The department head could post these promises on the department's website.
Some rule breaks are not crimes. Even so, a court can order the person to pay a fine. The bill sets out one clear way to ask a court for these fines. The head of the department could ask. So could the head of Medicare at Services Australia, the government agency that pays Medicare claims. They could let senior staff do this for them.
Say a clinic keeps losing records it must keep. Today the department can ask nicely or take the clinic to court. With this bill, it could send a fine notice first.
Tougher fines and clearer crimes
The second part rewrites many crimes and fines. The old laws only covered false statements, such as a signed form. Many claims now go through apps, card machines and computers. Nobody signs a statement. So the bill would cover false details given in any way.
Knowingly giving false details in a Medicare or child dental claim would still mean up to 5 years in jail. The top money fine would be three times as big.
Many rule breaks would have three options. The first is a crime where you meant to do it, with the biggest fine. The second is a crime with a smaller fine. For this one, the court does not need proof that you meant to do it. The third is a court fine that is not a crime at all. This lets a small slip be treated more lightly than cheating on purpose.
Doctors must tell you before a visit if Medicare will not pay for it. The top fine for not telling you would be 20 times as big. A doctor banned from Medicare can still see patients, but Medicare will not pay. The same bigger fine applies if they do not tell you first.
Doctors would have to keep billing records for 5 years, up from 2. Specialists would keep the letter from your GP that sent you to them for 5 years, up from 2. They would get 14 days to hand it over when Medicare staff ask, up from 7. Test labs would keep records for 5 years, up from 2. Scan clinics, such as X-ray clinics, would also keep records for 5 years.
Some government staff see people's private Medicare details. If they misuse them, they could get up to 2 years in jail. This also covers past staff. Today it is only a small fine.
More time to go to court
Today, some medicine scheme crimes must go to court within 3 years. Some cheating is hard to find that fast. The bill changes this for crimes that can bring more than 6 months in jail. For those, a case could start at any time, even years later. Smaller crimes keep the 3 year limit.
Some serious health crimes can be dealt with in a local court, which is quicker. Today the top jail term there for these crimes is 6 months. For most other national crimes, a local court can give up to 12 months. Under the bill, a person found guilty of most of these health crimes in a local court could also get up to 12 months.
Safety net cards and chemists
Families who spend a lot on medicine can get a safety net card. It makes their medicines cheaper once they have spent a set amount. Today, the form must be posted or taken to an office. The bill would let people apply online.
There would be a new way to cancel a card if a person should not have it. The department could then cancel cards online. The department would write first and give you 14 days to reply. If it cancels the card, it must tell you within 14 days.
Chemists hand out these cards. A chemist who knowingly gives a card to someone who should not have it could face up to 2 years in jail.
Special government panels can look into how a chemist works. The bill would let these panels ask for papers by letter. The person would not have to come in to a meeting. The rule on hard questions stays as it is now. A person must answer, even if the answer could show they broke the law. There is one exception. A person who is already charged with that crime, and whose case is not over, does not have to answer.
Getting papers and money back
The third part gives the department head a new power over the medicine scheme. If they have good reason to think anyone holds useful papers or details, they could send that person a letter. The person would have to hand them over. Today they can only ask a chemist for papers the law says chemists must keep. One example is the doctor's note that lets you buy a medicine.
Once you get a letter, you must keep the papers safe until the department says you can stop. If you lose them for reasons out of your control, you will not be fined.
The department could also win back medicine scheme money paid when it should not have been. It could get it back from the person paid, or from the person whose mistake caused it. This applies even if the money was paid by an honest mistake. When the money is taken back this way, there is no extra fine on top.
The department could take the money out of future payments. It could also tell someone who holds money for the person, such as their bank, to pay that money to the department.
Doctor billing checks
Professional Services Review is an independent agency. It checks whether doctors and dentists bill Medicare in a way that is not right. A panel of other doctors who do the same kind of work can look into a case. The doctor may have to pay money back or be banned for a time.
The fourth part changes how these panels work. A hearing is a meeting where the panel asks the doctor questions. The law would say a panel's check starts on the day of its first hearing. If a panel member can no longer do the job, someone else could take their place. A member whose time on the panel runs out could stay to finish a case. If the papers that set up a panel have a mistake, they could be fixed.
A panel would get 18 months to send its final report, up from 6 months. The head of the agency, called the director, could give more time if the doctor is overseas. The director would get 18 months, up from 12, to check a company or a company boss.
Today, if a company under review refuses to hand over papers, Medicare stops paying every doctor who works for it. That could leave many patients without care. The bill would limit this to the company or person under review. The director could also ask the Federal Court, a national court, to make any person under review hand over papers.
Bans after fraud charges
Today a special panel decides if a doctor convicted of Medicare fraud can stay in Medicare. The government says other bodies now do most of this job. One is the national body that registers doctors and other health workers. It can take away a doctor's right to work.
The fifth part ends that panel. The head of the health department would decide instead. This also covers dentists in the child dental scheme.
If a doctor is charged with Medicare or dental fraud, the department head must decide what to do. They could do nothing, have a talk with them, or give a formal warning. They could also stop Medicare paying for some or all of their work. This lasts until the court case ends or the department head lifts it.
Say the doctor is found guilty, and can no longer ask a higher court to change that. Then the department head could ban them for up to 5 years. They could also make the doctor pay back Medicare money linked to the crime.
The same can apply to a company charged or found guilty, or to its bosses. Then the department head could choose to stop Medicare payments for some doctors who work for that company. They would have to pick which doctors. A doctor who leaves the company can ask for this to be lifted.
Test labs give Medicare a written promise to follow its rules. If a lab breaks it, the department head could cancel the promise and order money paid back. Medicare could also stop paying for its tests for up to 5 years.
A doctor or lab facing one of these decisions would get a copy of the facts the department head is using. A stop on payments while a case runs starts the day the doctor gets the letter. Bans and other decisions start 28 days after the letter arrives. People can ask the Administrative Review Tribunal, an independent body that checks government decisions, to look at the decision. Cases the old panel has already started would carry on under the old rules.
Smaller changes
The last part tidies up wording. It writes down once, in each law, who counts as a department staff member. This saves repeating long wording. Nothing changes for staff. It also says chemists, doctors and hospitals must use the official form when they apply to hand out medicines the government pays toward.
Waiting in the House
The whole law would start the day it is signed into law by the Governor-General, the King's representative.
Mark Butler brought the bill into the House of Representatives on 28 October 2026. On the same day he gave his speech on why it is needed. The House of Representatives and the Senate are the two parts of Parliament. Next, the House will debate the bill and vote. Then the Senate must pass it too. If either says no, it does not become law.
Its journey through Parliament
| 28 Oct 2026 | House of Representatives: Introduced and read a first time |
| 28 Oct 2026 | House of Representatives: Second reading moved |