Review of Compliance Audit Decision

Information to assist you to understand and apply for a review of audit decision which has been made as a result of compliance audit.

Page last updated: 26 May 2017

Requesting a review of decision
Notice of the review decision
Application to Review Compliance Audit Decision form

Requesting a review of decision

To request a review you must complete the Application to Review Compliance Audit Decision form.

A review of decision is where an independent decision maker reviews the result of a compliance audit and reconsiders the evidence and confirms, varies or revokes the original decision.

A review of decision can be made under any program including MBS, PBS, CDBS and incentive programs.

For MBS and CDBS compliance audits, the following conditions apply:
  • it relates to a MBS or CDBS service or services
  • these services occurred on or after 9 April 2011 for MBS, or 1 January 2014 for CDBS
  • there is an amount recoverable
  • the application for review is received within 28 days following the receipt of the Notice of Audit decision and amounts recoverable letter
If any of the above criteria do not apply, you can request an administrative review of decision in relation to a compliance audit.

When making an application for review, you may provide additional information in order to substantiate the benefit paid for a service. This will ensure the Review Officer has all the relevant information to undertake the review.

When applying for a review of a decision make sure you:
  • use the approved application form provided on our website
  • ensure the application form is accurate and complete
  • attach any additional information and submit this with the application
For further guidance on the types of documents that may substantiate a service, please refer to the appropriate Health Professional Guidelines.

Notice of the review decision

You will be advised when your application for review is received and whether it meets the requirements for a review of decision. A Review Officer, who was not involved in the original audit decision, will conduct the review.

The Review Officer will conduct an examination of all the relevant facts and evidence available at the time the audit decision was made and will consider any new information submitted with the application.

After the review, the original decision will be confirmed, varied or revoked by the decision maker. Each audit decision can only be reviewed once.

Written notice of the review decision will be sent to you within 28 days after your application is received. An administrative review of decision is usually completed within 3 months.

Send the completed Application to Review Compliance Audit Decision form to the Health Provider Compliance Review Team.

Submitting completed form
Compliance Review Team
Provider Benefits Integrity Division
GPO Box 9848
Canberra ACT 2601

or scan the completed form and email Compliance Review Team

Application to Review Compliance Audit Decision form

Use this form to request a review of decision of a compliance audit under subsection 129AAJ(1) of the Health Insurance Act 1973 or section 56D of the Dental Benefits Act 2008. This review is available if you disagree with the amounts that have been deemed recoverable as a result of a compliance audit.

Application to Review Compliance Audit Decision form