Medical Officer Class 3

2 weeks ago

Canberra, Australia National Health Funding Body Full time

**Job Reference Number **23-BIDHDIV-16343

**Classification **Medical Officer Class 3

**Job Title **Medical Officer Class 3 (Several Positions)

**Division **Benefits Integrity and Digital Health Division

**Branch **Compliance Enforcement and Professional Review Branch

**Section **Professional Review Section

**Location **Canberra ACT, Parramatta NSW, Melbourne VIC, Brisbane QLD,
Adelaide SA

**Status **Ongoing

**Employment type **Full-time & Part-time

**Salary Range **$153,625 to $160,847

**Security Clearance **Baseline

**Mandatory Qualifications **Qualification as a Medical Practitioner; Registration as a Medical
Practitioner with APHRA; minimum Baseline security clearance
or the ability to obtain.***

**Contact Officer Name**:Carolyn Fogarty
**Phone**:07 3360 2959

**Eligibility**
- To be eligible for employment with the Department of Health and Aged Care

applicants must be an Australian citizen at the time an offer of employment is made
- An applicant’s suitability for employment with Health will also be assessed through a

variety of pre-employment check processes, such as:

- Satisfactory completion of an Australian Federal Police criminal history check,

and where relevant a Working with Children and Vulnerable People Check.
- Completion of a medical declaration and pre-employment medical (where

required).
- Providing evidence of qualifications.

**Division Responsibilities**

Benefits Integrity and Digital Health Division (BIDHD) is responsible for maintaining the

affordability of medical services in Australia by protecting the integrity of Medicare

payments. BIDHD achieves this through:

- Identification, and treatment of incorrect claiming, fraud and possible inappropriate

practice by health care providers and suppliers
- Supporting health care providers by delivering education and information on the

appropriate use of Medicare and with digitally enabled programs to support clinical

care and health payments
- Managing pharmacy approvals and pathology rents regulations.

**Branch Responsibilities**

The Compliance Enforcement and Professional Review Branch delivers a risk-based

compliance program with staff actively engaged in intelligence driven implementation of

compliance activities that are commensurate with identified risk.
- Professional Review Section - under the Practitioner Review Program (PRP), review

and interact with health practitioners regarding their Medicare servicing and

Pharmaceutical Benefits Scheme (PBS) prescribing.
- Civil Administration and Enforcement Section - conducts compliance activities

associated with Approved Pathology Collection Centres, Pharmacy compliance and

Corporate Compliance
- Health Provider Fraud Section - conducts analysis of suspected fraud cases and

conducts investigations into cases of fraud and fraud-related non-compliance for

referral of cases to the CDPP.

**Section Responsibilities**

The Professional Review Section seeks to protect the integrity of Medicare and the PBS

through the administration of the PRP. The aim of the PRP is to improve compliance by

reducing inappropriate practitioner rendering or initiating of services under Medicare

and/or prescribing under the PBS. This includes reviewing health practitioners' Medicare

servicing and PBS prescribing, identifying areas of potential concern and interacting with

practitioners to discuss these concerns. Corporate entities are also reviewed under the PRP.

The PRP function also includes exercising delegation under the Health Insurance Act 1973 to

request the Director Professional Services Review (PSR) to review cases of possible

inappropriate practice where concerns cannot be resolved within the Program.***

**Key Responsibilities**
- Under the Department’s PRP, assist in identifying and assessing health practitioners

who may be claiming Medicare benefits, ordering tests, or prescribing

inappropriately
- Draw on clinical knowledge of contemporary practice, and analyse data from a

range of data tools to identify possible non-compliance with Medicare and PBS

requirements or possible inappropriate practice. This may include considering

whether:

- a practitioner’s practice/conduct when providing or initiating Medicare

services or prescribing PBS medicines would be unacceptable to the general

body of their peers.
- Medicare Benefits Schedule (MBS) and/or PBS requirements have been met
- services are medically necessary and clinically relevant, that is, generally

accepted by the relevant profession as necessary for the appropriate

treatment of the patient
- Managing a case load of practitioners under the PRP, including:

- conducting practitioner interviews and/or practice site visits to communicate

concerns of possible inappropriate practice effectively and professionally,
- seek practitioner responses,
- determine whether concerns remain and
- prepare concise written reports and correspondence to practitioners under

review to advise on your findings, outco

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