New Government schemes and your Medicare provider number – guard it well

Once upon a time we graduated, applied for and received a Provider Number from the Department of Health and Ageing. This number is specific to a location and any dental practitioner working in multiple locations requires a number for each one. For many dentists once received there is no further thought about the number, its intention or its potential for abuse and in most cases it travels along in our practicing lives as a silent partner.

In recent years there have been some alarming developments resulting in misuse or appropriation of provider numbers. The rationale of the provider number is so that practitioners can access Medicare (MCA) funding, which for many years this was limited, in the case of dental practitioners, to accessing radiographic services and a few other ancillary medical services. MCA has also restricted the use of item numbers for many services to specialist groups (such as CBCTs).

Recent challenges have emerged with the introduction of government schemes: the one most prominent in our minds being the CDDS and the problems faced by a profession not provided with adequate education or briefing by MCA, nor used to working with a government funded scheme and its inherent red tape. It has been estimated that over 10,000 dentists provided treatment under the CDDS scheme and a great number of those were unwittingly non-compliant with Section 10. Guild Insurance worked exhaustively with the ADA branches and Meridian Lawyers to lobby, advise and appeal to MCA in an effort to assist all members who had audits and by inference, all vast number who carried a liability for non-compliance of paperwork.

It was during this time that as practitioners we became aware of the value of our provider numbers: it was the first time that the majority of dentists had accessed public funds. It also brought to light some examples of misuse of the numbers in certain cases.

One unfortunate case had a group of volunteers in a remote indigenous community providing services and allowing the managers of the centre to bill for services: once they had done their time (usually a week) they moved off and left the mangers to it: however it transpired that the paperwork was not submitted correctly which, in MCA eyes meant that the dentists were fair game for prosecution. In some ways if this case had have made it to the papers with all the buzz words (volunteer, indigenous remote, service access) it may have engendered some sympathy for dentists after all the negative press we had received. However, after due consideration and representation by Meridian Lawyers on behalf of these members, MCA agreed to waive the investigation – possibly they also considered the bad press for them!

Unfortunately other changes in the landscape of our professional lives are having an impact. Some ADA branches have become aware of employees being pressured to act unprofessionally (over servicing), and of employees being held accountable for decisions made by employers particularly where the practice owner or corporation processes all paperwork and the employee “loses sight” of what is being processed or claimed under his or her provider number. In the eyes of Medicare each practitioner is responsible to ensure that their number is used correctly and that no activity occurs that could be construed as inappropriate (meaning fraudulent) If you feel that you are potentially the subject of such abuse of the mandatory notification provisions of the National Law, please contact your ADA Branch immediately to discuss what you should do.

We also have new government schemes either just introduced or on the horizon and we are all feeling a bit battle weary after the CDDS experience. Not only should members ensure that they understand the terms and requirements of any new scheme (including limitation of services) but they should ensure that they have control over the provider number as the liability engendered by its misuse rests with the owner of the number, not the practice.

Please refer to newsletters, alerts and websites of your branch ADA office for fact sheet and guidance when the new schemes are introduced, or contact the professional advisors/consultants with any concerns you may have. Guild and the state branches are fully prepared once details have been confirmed, to make sure that members have the information available to ensure compliance and thus practice safely and avoid liability. Please make sure you are fully briefed before entering into any government scheme so that lessons learnt are not mistakes repeated.


Dr Eryn Agnew
Community Relations Manager/Professional Consultant