We are continually developing education material to help with CDBS compliance audits and reviews of dental services.
All health compliance audits and reviews, including for CDBS, are conducted in accordance with legislation to protect public funds and make sure benefits are correctly paid.
The Dental Benefits Legislation Amendment Act 2014 (the Act) includes provisions that significantly change the way we can conduct CDBS compliance audits and reviews of dental services.
Under the Act:
- if you don’t voluntarily provide substantiating documents during a CDBS audit and we have reasonable concern that a dental benefit has been incorrectly paid, we can issue you, or the entity in possession or control of your records, with a Notice to Produce substantiating documents
- civil penalties can be applied if the entity in possession or control of your records fails to comply with the Notice to Produce
- if you do not substantiate claims made under your name or provider number for CDBS services, you may have to repay the benefit paid for those services
- you can seek a ‘review of decision’ for a CDBS compliance audit outcome
The Guideline for substantiating dental services provided under the CDBS can help you understand what documents to use to substantiate services during a health compliance audit or review.
You can provide substantiating documents with clinical information to one of our medical practitioners. You can censor any details of a patient's clinical information you think are not relevant.
Dental practitioners can be reviewed under the Professional Services Review scheme for any CDBS service provided on or after 4 November 2014. We can request the Director of Professional Services Review to review cases of possible inappropriate practice.
- Make sure you know all your requirements under Health Professional Compliance
- Read more about health compliance audits and reviews
- Keep up to date with our Health Professional guidelines
- Read more about the Child Dental Benefits Schedule for health professionals
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