Medicare and pharmaceutical benefits

Most people make claims under the Medicare and Pharmaceutical Benefits schemes (MBS and PBS) for a range of health services they receive in Australia.  Health service providers regularly need to exchange relevant information with Medicare Australia in order to process these claims.

The Privacy Act (and specific secrecy provisions in other legislation) protects information collected by the Government through the MBS and PBS. Due to its sensitivity, the handling of MBS and PBS information is also regulated by legally binding guidelines issued by the Privacy Commissioner.

These guidelines are issued under the National Health Act 1953. The guidelines cover all government agencies who handle MBS and PBS information, in particular Medicare Australia and the Department of Health and Ageing.  Those agencies must inform the Privacy Commissioner about certain matters under the guidelines. A person may complain to the Privacy Commissioner if they feel that a breach of the guidelines has occurred.

The guidelines:

• require that claims information from the MBS and PBS is not stored together
• specify when claims information from the two programs may be linked
• prohibit claims information over five years old from including information that could identify an individual
• specify the circumstances in which old information may be re-linked.

Other places to go:

• Privacy Guidelines for the Medicare Benefits and Pharmaceutical Benefits Programs
• Explanatory Statement for the Medicare Benefits and Pharmaceutical Benefits Programs
• Report of the Privacy Commissioner's Review of the Privacy Guidelines for the Handling of Medicare and PBS claims information