🇦🇺Australia

Duplicate Payment Audit Recoveries

2 verified sources

Definition

Routine audits detect MBS billing alongside ABF for same episode, leading to recalls and repayments.

Key Findings

  • Financial Impact: Full MBS benefit repayment per duplicate episode (AUD 100-500 typical)
  • Frequency: Identified via routine Commonwealth data matching
  • Root Cause: Manual failure to cross-check episode funding sources

Why This Matters

The Pitch: Home Health Care wastes AUD 10,000+ annually on recovered duplicate MBS claims. Automation flags funding overlaps before submission.

Affected Stakeholders

Hospital billing agents, Episode managers

Deep Analysis (Premium)

Financial Impact

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Current Workarounds

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Methodology & Sources

Data collected via OSINT from regulatory filings, industry audits, and verified case studies.

Evidence Sources:

Related Business Risks

Incorrect MBS Billing Rates

AUD 25% of MBS fee per episode rejected (e.g., AUD 50-200 loss per claim)

Bulk Billing Co-Payment Charges

100% repayment of Medicare benefits plus potential fines (AUD 1,000+ per incident)

Delayed Claims from Incomplete Documentation

20-60 days Accounts Receivable delay per claim (2-5% effective revenue drag)

WHS Risk from Inadequate Aide Competency

AUD 10,000 - 50,000 per WorkCover claim for aide-related incidents

Provider Supervision Non-Compliance Fines

AUD 10,000 - 100,000+ per incident in fines and enforcement costs

Supervision Time Overruns

AUD 2,000 - 5,000/month per team in supervisor overtime at AUD 100/hour

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