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
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 auditing purposes. Non-compliant claiming can result in an education process, financial recoveries or other actions.
These assurance 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.Back to top
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.
- Rules – we make unambiguous rules available in the Notes and Fee Schedules.
- Education – when honest mistakes are made we will provide further education to help you to understand our rules.
- 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 assurance audit, please refer to this overview of the process.Back to top
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 audit provider records for more serious forms of non-compliance. These audits 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 audit identifies potentially fraudulent behaviour, we will refer the provider for fraud investigation and criminal prosecution may result.
As part of its assurance 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.Back to top
Send an email to Assurance at assurance [at] dva.gov.au for more information about our assurance activities or to make contact with one of our Assurance Officers.
The Assurance mailbox is secure and all contact will remain private and confidential.
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.Back to top