Complying with DVA health programs

When you care for our clients, you agree to accept our fees and conditions of treatment. There can be consequences for providers who do not follow these requirements.

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DVA provider obligations

Our fees and conditions of treatment are detailed in the DVA Notes and Schedule of Fees relevant to your profession.

It is your obligation to be familiar with and adhere to the rules in both of these documents if you claim for treatments provided to our clients.

We regularly monitor provider claims to ensure that:

• appropriate services are being provided and claimed for, in adherence with the Notes and Fee Schedules
• any referrals and claiming requirements are met.

We may request your records for integrity assessment purposes. Non-compliant claiming can result in an education process, financial recoveries or other actions.

These activities ensure public monies are appropriately spent and that our clients receive treatments and services that are clinically appropriate and of the highest quality.

For providers who have a contract with DVA to provide services or supply products, the conditions you need to adhere to will be specified in your contract.

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Complying with DVA rules

To assist providers in meeting their obligations, we use a 3-tiered approach to compliance. This approach has a focus on early intervention and prevention.

1. Rules – we make unambiguous rules available in the Notes and Fee Schedules.
2. Education – when honest mistakes are made we will provide further education to help you to understand our rules.
3. Enforcement – we deal effectively with those who exploit our health programs.

Even when payments are claimed in error, we are obligated by law to recover the money.

Additional compliance information is available for allied health providers, including:

• Complying with the DVA Notes — A list of the key clauses that all allied health providers must follow when they work with us.
• Common compliance issues for allied health providers, which may result in declined claims or other action.

For providers undergoing an integrity assessment, please refer to this overview of the process.

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Action on non-compliance

DVA regularly reviews our health programs to identify compliance issues.

These reviews include:

• analysis of provider claiming patterns
• environmental scanning
• tip-offs from the sector.

We assess provider records for more serious forms of non-compliance. These assessments include:

• a review of all claims for payment
• analysis of clinical notes by DVA health advisers
• a check that treatment is compliant with our rules, and that clients are receiving clinically appropriate treatment.

In cases where we identify non-compliant behaviour, we give you the opportunity to discuss and clarify our concerns.

Non-compliant activities can result in:

• an education process about our requirements
• debt recovery action, where you will have to repay funds that we paid to you.

In serious cases we may terminate your DVA provider registration.

If an assessment identifies potentially fraudulent behaviour, we will refer the provider for fraud investigation and criminal prosecution may result.

As part of our activities, we also consult with health sector peak bodies to identify factors which may affect their members’ compliance and initiate strategies to address non-compliant behaviours.

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Contact us

Send an email to us at integrity [at] dva.gov.au (integrity[at]dva[dot]gov[dot]au) for more information about our activities or to make contact with one of our Integrity officers.

The Integrity mailbox is secure and all contact will remain private and confidential.

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Fraud investigation

Fraud against the Australian Government is defined as 'dishonestly obtaining a benefit, or causing a loss, by deception or other means'.

For detailed information about DVA’s fraud investigation process, including how to report fraud, please refer to Reporting Fraud.

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