Medicare claims for professional sportspeople not allowed

12 Jun 2014

The Department of Human Services (DHS), as part of a recent review, has identified that claims for Medicare benefits have been incorrectly made where a professional sportsperson’s employer is liable for, or has paid for the medical service, or where the services was provided for purposes connected to a professional sportsperson’s employment. DHS will soon be writing to health professionals, sporting bodies and player’s associations to advise them the circumstances in which Medicare benefits cannot be paid.

Under subsection 19(3) of the Health Insurance Act 1973 (the Act), Medicare benefits are not payable in respect of a professional service in circumstances where the patient’s employer is liable for, or has paid for, the service, or where the service was connected with the persons employment.