Notice to Produce
A Notice to Produce is a written notice requiring a health or dental practitioner, or person in possession or control of records, to produce documents that can substantiate the services being looked at as part of a compliance audit.
- A reasonable concern
- Complying with a Notice to Produce
- Identifying Errors
- Failure to comply with a Notice to Produce
If you provide documents that verify only some of the services under review or don't respond to our requests, we can send you a formal notice to provide substantiating documents.
If you provide documents that verify only some of the services under review or don't respond to our requests, we can send you a formal notice to provide substantiating documents.
- a reasonable concern that a payment of a benefit may be more than the amount that should have been paid
- sought advice from a Health Professional employed by us
- consulted with a relevant professional body about the types of documents that can help substantiate the service.
A Notice to Produce includes the following information:
- an explanation of the reasonable concern
- details of the benefit or services that need to be substantiated, and
- the type of information that can help substantiate those services.
The Health Professional Guidelines are available to help you understand more about what documents and information you can use to substantiate services and claims, if you are asked to participate in a Health compliance audit or review.
A Notice to Produce documents cannot be issued to a patient or their parent or legal guardian.
A reasonable concern
A reasonable concern is where we believe that a benefit paid for services exceeds what should have been paid. It doesn’t relate to the clinical relevance of the service provided.
For example, if a MBS benefit is only payable for a service when a specific test is undertaken, we will ask the person to produce documents that demonstrate that the test was performed.
Complying with a Notice to Produce
When you submit documents, only provide information you think will help us determine whether or not the services you have claimed should have been paid.
You are not expected to produce documents that contain clinical information about your patients unless it is needed to substantiate a claim. Clinical details that aren’t needed for this purpose can be censored. If clinical records are needed to substantiate services you can elect to submit the information to one of our Health Professionals such as one of our medical advisors.
To help you determine the type of documents that may substantiate a service we, in consultation with relevant professional bodies, have developed a set of Health Professionals Guidelines.
Identifying Errors
If you identify a claiming error when providing documents as a result of a notice to produce, you should tell us as soon as possible by voluntarily acknowledging an incorrect payment. You can do this by completing the Voluntary Acknowledgement of incorrect payments form.
Administrative penalty amounts may be reduced if you choose to voluntarily acknowledge an incorrect payment before the date specified in the notice. If you voluntarily acknowledge an incorrect payment, we will contact you to confirm how much you owe.
Read more about Voluntary Acknowledgement
Failure to comply with a Notice to Produce
If you don’t comply with a Notice to Produce documents within the required timeframe the individual or corporation may be liable for a civil penalty. We will also raise a debt for the identified unsubstantiated services and can increase the administrative penalty where applicable.