Now lawHealth & Care Introduced in the Senate, 23 Jul 2025

Bulk billed claims now usually have a one year limit

This health law tightens how Medicare guards against wrong and dishonest claims. A review put these at $1.5 to $3 billion a year. The law also gives the medicines watchdog new tools for shortages and vapes. And it tidies up tobacco rules.

Official name: Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2025

Who it affects

• Family doctors, specialists and dentists who bulk bill: They now have 1 year to send in most bulk billed claims. Officials can allow longer in fair cases.
• Health workers being investigated: They face wider powers to look into them. They face new fines if they ignore a notice to hand over facts.
• Pharmacists who want to open or move a pharmacy: Asking the minister to overrule a rejection is now one step of up to 4 months. They must wait 12 months before asking again.
• Patients who need medicines that are hard to get: The watchdog can approve an overseas swap when a shortage is likely. It does not have to wait for it to happen.
• Vape and tobacco sellers: They face clearer ad bans, more inspectors and new powers to take their goods.

Wrong Medicare claims cost billions

Three schemes help pay for health care. Medicare helps pay for doctor visits. The Pharmaceutical Benefits Scheme makes medicines cheaper. This article calls it the medicine subsidy scheme. The Child Dental Benefits Schedule helps pay for kids' dental care. In 2023-24 these payments came to at least $65.1 billion.

An independent review led by Dr Pradeep Philip looked at how well Medicare is kept safe from wrong and dishonest claims. It found most health workers do the right thing. But it said between $1.5 billion and $3 billion a year is lost to people not following the rules. It said the rules for catching and stopping this were patchy and weak.

Health Minister Mark Butler brought this bill to respond to that review. It also bundles in changes about medicines, vapes and tobacco. It has four main parts.

Shorter time to lodge claims

When a doctor bulk bills you, they claim the Medicare money directly. Before this law, they had up to 2 years after the visit to send in that claim. Now the usual limit is 1 year.

The same change applies to claims for child dental care paid straight to the dentist.

The government says most claims are already made within a year, so the change should matter little. Officials can still allow a late claim. For Medicare claims it is the minister. For dental claims it is the Chief Executive Medicare. That is the top Medicare official at Services Australia, the agency that pays Medicare money.

Say a small clinic's billing system breaks and some claims are stuck for 14 months. The clinic can ask for more time. Officials can say yes if it truly could not claim sooner.

Simplified billing is a different type of billing, used with private health insurers, set up under a 2024 law. It keeps the 2 year limit.

Wider Medicare fraud powers

Investigators have powers to search places and to keep proof. They need the owner's permission or a warrant, which is a court's order to search. Before this law, those powers only covered a short list of crimes.

They did not work well for many crimes in the Criminal Code, the main book of federal crimes. They also did not work well for fraud against the medicine subsidy scheme.

The law widens the list. It now includes crimes like dirty money, forgery, meaning faking papers, and identity fraud when they are about health payments. The same set of powers now applies to all these crimes.

Pharmacy approval changes

To sell medicines under the medicine subsidy scheme, a pharmacy must meet rules about where it can open. If a pharmacist's request fails those rules, they can ask the health minister to approve it anyway.

That used to take two steps, and each step could take up to 3 months. Now it is one step of up to 4 months. If the minister says no, the pharmacist must wait 12 months before asking again for the same shop.

The minister can also hand the job of setting the request form to an official. The Australian Community Pharmacy Authority checks these requests. Its members now serve 3 year terms, up from 2.

Information and repayments

Part 4 lets the Chief Executive Medicare send a notice to anyone. The notice can ask them to hand over facts, papers or things linked to running Medicare. This applies when there is good reason to think the person has them.

Ignoring a notice is a crime even if you did not mean to break the rule. The top fine is 30 fine units. A court can also order a fine of up to 30 units for a person or 150 for a company. A fine unit is a set dollar amount used to work out federal fines.

A new section lets Medicare take back money paid to someone who should not have got it. It also covers money paid when the legal rules were not met.

If a doctor broke the rules, the money can be taken back from the doctor. That way the patient is not left out of pocket. Money can only be taken back once.

People now have 45 days, up from 28, to ask for a review of a decision to take back a debt.

Evidence shared with regulators

The Professional Services Review is the agency that checks whether doctors have given and billed for care properly. It can make doctors hand over papers. There were limits on using those papers as proof in other cases.

The law loosens some of these limits. Papers can now be used in debt cases and in cases about failing to hand over records.

Ahpra is the body that signs up health workers. Ahpra and the national health boards can now use the papers to start their own probes. They can also use them as proof in their cases.

Medicine shortages

Part 2 changes the Therapeutic Goods Act 1989. That law sets the rules for medicines, medical devices and vapes. The Therapeutic Goods Administration runs it. This article calls it the medicines watchdog.

Some overseas medicines are not approved for sale here. Before, the watchdog could only let one in once a local medicine had already run out. Now it can act when a shortage is likely soon. The government says overseas stock may only be there for a short time. Other countries may want it too.

The same goes for products made from human cells or tissue, and for medical devices.

Vapes and enforcement

Some changes back up the 2024 vaping changes. Detailed rules can now ban dealing in vaping goods covered by an agreement Australia has signed with other countries. The watchdog can order people to stop spreading general facts about vapes.

Powers to inspect and search now match the usual federal rules. Things taken under any of these powers can now be kept by the government for good. Before, this only applied to things taken under one type of warrant.

The head of the watchdog can now give orders people must follow when it helps public health and safety. Before, the test was that an order was needed to protect health and safety. That was harder to meet.

Some state and territory officers can now be given powers to demand facts and papers about broken rules. The government says it will look at ways to protect privacy before handing over these powers.

Other medicine rules

Some products made from human cells or tissue can be used with permission, under conditions. Breaking a condition now brings crimes of different levels and a court fine. This matches the rules for medicines and devices.

The watchdog no longer has to publish the names of its officers, because of worries about privacy and safety. Detailed rules can say when a doctor must not get permission to prescribe products that are not approved.

Deciding whether something counts as a medical product is now treated as making law. So people can no longer apply for that decision. They can no longer ask for a review if the watchdog refuses to make one.

The law also makes clear that a rule letting the watchdog release facts is not a secrecy rule. Medicines Australia speaks for medicine makers. Complementary Medicines Australia speaks for makers of vitamins and herbal medicines. Both spoke against this change when asked. They said it was not needed.

Tobacco and vape ads

Part 3 changes the Public Health (Tobacco and Other Products) Act 2023, the main tobacco law. Vape ads are now clearly banned under both the tobacco law and the medicines law. Some exceptions were removed.

The ban on tobacco and vape sponsorship used the word individual. That might have covered only people. It now says person, so companies are clearly caught.

Detailed rules can set times to bring in new packet rules and phase out old ones, such as new health warning pictures. That lets shops sell old stock for a set time without breaking the law. Any federal public servant can now be made a tobacco inspector.

Start date

The bill went into the Senate, Parliament's second house, on 23 July 2025. It passed there on 29 July 2025. The House of Representatives, the lower house, passed it on 1 September 2025.

The Governor-General, who stands in for the King, signed it into law on 4 September 2025. It became Act No. 38 of 2025. Most parts started the next day.

The 1 year claim limit applies to care given after it started. Some parts are timed to line up with a 2024 Medicare billing law.

How they voted

Its journey through Parliament

Official sources

• Bill page on aph.gov.au
• Text of the bill
• Explanatory memorandum

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