Operational Blueprint Document (lex 81704): Suspected Medicare Fraud And Business Integrity (bi) Flags 110-15030000 (effective From 29 August 2024. 1 Document Released In Part. LEX 81704 Sections Of…

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Services Australia released an operational blueprint detailing procedures for identifying and managing suspected Medicare fraud through Business Integrity (BI) flags, effective from 29 August 2024. The document defines fraudulent activity including false claims for services not provided, identity fraud, altered receipts, unauthorised use of Medicare cards, and PBS medicine diversion. When BI flags are triggered—indicating compromised customer details or illegitimate claims—they restrict myGov linking and prevent further fraudulent activity on affected records. The procedure outlines staff workflows for processing claims and issuing replacement Medicare cards when flags are active, with escalation to the Department of Health and Aged Care for provider-related fraud. Substantial portions were withheld under section 37 (secrecy laws), limiting public visibility of specific operational processes and decision-making criteria.