Australian Government - Department of Health - Office of Hearing Services
Hearing Services Program

Lessons learnt from Compliance Monitoring and Audits

Through compliance monitoring and the completion of provider audits in 2015/16, some common areas of non-compliance were found. These often result in claim recoveries. To support you in improving compliance, information on the common issues and how to prevent them is provided below.

Vouchers not valid at the date of service

Services are sometimes delivered prior to vouchers being issued or after vouchers have expired. Please ensure you check your clients’ voucher status prior to delivering services.

Incomplete or missing medical certification

Providers sometimes issue vouchers on behalf of their clients without the correct medical certification being provided. Please ensure you sight and file the medical practitioner certification regarding contraindications before issuing a voucher for a client.

Even when the medical certificate indicates that clients have contraindications for the fitting of a device, they may still be able to receive other services through the program.

Clients being provided services privately when they were eligible for services under the program

Several client files lacked evidence to show that the client was offered services available to them under the program, including fully subsidised devices. Please ensure clients are offered the services available to them under the program and ensure client decisions are fully documented on the client file.

Lack of evidence in file notes to substantiate claims

Some providers do not have adequate documentation on file as evidence that a service occurred or that the service met the requirements of the program. Evidence includes correctly dated records, detailed client histories, notes on goals and needs, notes on the discussion of device options and quotes for partially subsidised devices. Please ensure you keep adequate and up to date client files, including detailed file notes.

Binaural maintenance being claimed for monaural clients

Providers sometimes claim binaural maintenance for clients who are monaurally fitted. Please ensure maintenance claims match fittings.

Lack of clarity over reassessment and client review services

Some providers claiming for both reassessment and client reviews are failing to distinguish between the different services provided under each claim item. Please ensure client file notes contain adequate detail to differentiate between reassessment services and client review services.

Missing authorisations from clients showing they agreed to transfer to a new provider

In some cases there is no documented evidence, signed by the client, that they have agreed to transfer. Please keep a signed transfer request on the client’s file.

Using old forms or criteria

Some providers are using outdated forms or guidance, particularly the Eligibility Criteria for Refitting (ECR). Please check our website (and review the ECR criteria) to ensure you are using the correct forms and guidance.

Lessons learnt from Compliance Monitoring and Audits (PDF 46 KB)

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