MEDICARE AUSTRALIA

MEDICARE AUSTRALIA

Medicare Australia. 2009 Personal Information Digest. Page 1 of 71 MEDICARE AUSTRALIA Table of Contents 1. PERSONNEL RECORDS . 5 2. OUTSIDE EMPLOYMENT APPLICATIONS . 5 3. SEPARATION QUESTIONNAIRES . 5 4. PROGRAM REVIEW DIVISION FILES . 6 5. COMMITTEES AND TRIBUNAL FILES . 7 6. INVESTIGATIONS INFORMATION FILES SYSTEM . 7 7. PROGRAM REVIEW DIVISION – GENERAL CORRESPONDENCE . 8 8. NATIONAL INTELLIGENCE SYSTEM . 8 9. AUSTRALIAN CRIMES COMMISSION (ACC) FALSE IDENTITY DATABASE . 9 10. PROJECT INFORMATION MANAGEMENT SYSTEM . 9 11. INVESTIGATORS’ AND MANAGERS’ DIARIES . 9 12. PROVIDER MONITORING SYSTEM .

10 13. PRISM DATABASE . 10 14. PHARMACEUTICAL BENEFITS INFORMATION SYSTEM REPORTS . 11 15. NATIONAL ASSESSMENT . 11 16. PROFESSIONAL SERVICES REVIEW SCHEME . 12 17. PROGRAM REVIEW INFORMATION FORM . 12 18. PRESCRIPTION SHOPPING PROJECT NATIONAL APPLICATION . 13 19. PRESCRIPTION SHOPPING INFORMATION SERVICE APPLICATION . 13 20. PRESCRIPTION SHOPPING INFORMATION SERVICE (PSIS) DOCTOR REGISTRATION DATABASE . 14 21. CENTRELINK DISABILITY SUPPORT PENSION DATABASE . 14 22. CENTRELINK IDENTITIES . 14 23. NATIONAL INTELLIGENCE – CUSTOMS . 15 24. UNAUTHORISED ACCESS DATABASE . 15 25. UNAUTHORISED ACCESS CASE FILES .

15 26. UNAUTHORISED ACCESS EXTRACTION FILES . 16 27. MEDICARE INFORMATION SYSTEM REPORTS . 16 28. MEDICARE PUBLIC ENROLMENT RECORDS . 17 29. MEDICARE AND DVA PROVIDER REGISTRATION RECORDS . 17 30. MEDICARE BENEFITS ADVISORY COMMITTEE APPLICATIONS AND DETERMINATIONS . 18 31. COMPENSATION RECOVERY PROGRAM . 19 32. AUSTRALIAN DEFENCE FORCE (ADF) FAMILY HEALTHCARE PROGRAM . 19 33. CORRESPONDENCE WITH THE GENERAL PUBLIC AND THEIR NON-MEDICAL REPRESENTATIVES . 20 34. MEDICARE CLAIMS HISTORY RECORDS . 20 35. PHARMACY APPROVAL FILE . 21 36. COLOSTOMY AND ILEOSTOMY MEMBERSHIP FILES . 22 37. PHARMACEUTICAL BENEFITS SCHEME: SAFETY NET .

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Medicare Australia. 2009 Personal Information Digest. Page 2 of 71 38. PHARMACEUTICAL BENEFITS CLAIMS HISTORY RECORDS . 23 39. REMOTE PHARMACY ALLOWANCE / ISOLATED PHARMACY ALLOWANCE . 23 40. AUTHORITIES PROCESSING SYSTEM . 23 41. REFUND PHARMACEUTICAL BENEFITS PATIENT CONTRIBUTIONS . 24 42. PATHOLOGY APPROVAL AND REGISTRATION SYSTEM . 24 43. AUSTRALIAN ORGAN DONOR REGISTER . 25 44. PHARMACEUTICAL BENEFIT SCHEME PATIENT ENTITLEMENT TABLES . 25 45. IN VITRO FERTILISATION AND GAMETE INTRA FALLOPIAN TRANSFER PROGRAM . 26 46. PHARMACEUTICAL BENEFITS PRESCRIBER SYSTEM . 26 47. PHARMACEUTICAL BENEFITS MAILING LISTS .

27 48. ISOLATED PHARMACY ALLOWANCE . 27 49. PHARMACEUTICAL BENEFITS BRANCH SOFTWARE VENDOR ASSISTANCE PAYMENT SYSTEM . 28 50. MEDICARE FAMILY SAFETY NET REGISTRATION . 28 51. SUMMARY COMBINED ARCHIVE MEDICARE DATA . 29 52. HEARING SERVICES PROGRAM . 29 53. AUSTRALIAN CHILDHOOD IMMUNISATION REGISTER . 30 54. GENERIC PRACTICE REGISTER . 30 55. MENTAL HEALTH NURSE INCENTIVE PROGRAM (MHNIP . 31 56. MENTAL HEALTH NURSE INCENTIVE PROGRAM (MHNIP) – ACCESS DATABASE32 57. MENTAL HEALTH NURSE INCENTIVE PROGRAM (MHNIP) – PATIENT INFORMATION . 32 58. NATIONAL EXTERNAL BREAST PROSTHESES REIMBURSEMENT PROGRAM....

32 59. PRACTICE INCENTIVES PROGRAM (PIP . 33 60. PRACTICE INCENTIVES PROGRAM (PIP) - Service Incentive Payments (SIP) , and SIP ACAI (Service Incentive Payments Aged Care Access Incentive . 33 61. PRACTICE INCENTIVES PROGRAM (PIP) – Access Database . 34 62. GENERAL PRACTICE IMMUNISATION INCENTIVES (GPII . 34 63. GENERAL PRACTICE IMMUNISATION INCENTIVES (GPII) - Section 46E Agreement . 34 64. MEDICARE TEEN DENTAL PLAN . 35 65. COMMUNITY PHARMACY AGREEMENT INTRANET DATABASE . 35 66. WESTERN AUSTRALIAN VISITING MEDICAL PRACITIONERS (WA VMP's) CLAIMS HISTORY RECORD . 36 67. SPECIALISED DRUG PATIENT DATABASE .

36 68. RURAL INCENTIVE PROGRAMS . 37 69. DVA VETERAN REGISTRATION (CROSS REFERENCE FILE . 38 70. DVA CLAIMS HISTORY RECORDS . 38 71. BOTULINUM TOXIN PROGRAM . 39 72. TRASTUZUMAB (Herceptin . 39 73. BOWEL CANCER SCREENING REGISTER . 40 74. SPECIAL ASSISTANCE SCHEME . 41 75. CO- ORDINATED CARE TRIALS . 41

Medicare Australia. 2009 Personal Information Digest. Page 3 of 71 76. DOCUMENTS CREATED WITHIN OR RECEIVED BY OFFICE OF LEGAL COUNSEL IN PERFORMING ITS ROLE OF PROVIDING IN-HOUSE LEGAL ADVICE AND LEGAL SERVICES . 42 77. INFORMATION REQUEST TRACKING SYSTEM (IRT . 42 78. FREEDOM OF INFORMATION REQUEST FILES . 43 79. IRIS DATABASE (INDIVIDUAL REQUEST INFORMATION SYSTEM) and STATE INFORMATION REQUEST DATABASES . 43 80. LSAC DATABASE . 44 81. CORPORATE DIRECTORY DATABASE . 45 82. INFORMATION DELIVERY SERVICES . 45 83. MEDICAL INDEMNITY PROGRAM . 46 84. MEDICARE LSPN REGISTER (LOCATION SPECIFIC PRACTICE NUMBER .

49 85. MEDICARE BENEFITS ADVISORY COMMITTEE FILE . 49 86. MEDICAL BENEFITS (DENTAL PRACTITIONERS) ADVISORY COMMITTEE FILE.. 50 87. MEDICAL BENEFITS (DENTAL PRACTITIONERS) APPEAL COMMITTEE FILE . 50 88. MEDICAL SERVICES COMMITTEES OF INQUIRY - COMMITTEE FILE . 51 89. PHARMACEUTICAL SERVICES COMMITTEES OF ENQUIRY - COMMITTEE FILE. 51 90. MEDICAL SERVICES REVIEW TRIBUNAL FILE . 52 91. MEDICARE PARTICIPATION REVIEW COMMITTEE FILE . 52 92. OPTOMETRICAL SERVICES COMMITTEES OF INQUIRY COMMITTEE FILE . 52 93. SPECIALIST RECOGNITION ADVISORY COMMITTEE (ONE FOR EACH STATE AND TERRITORY) - COMMITTEE FILES .

53 94. SPECIALIST RECOGNITION APPEAL COMMITTEE (ALL STATES AND TERRITORIES) - COMMITTEE FILE . 53 95. GENERAL PRACTICE RECOGNITION ELIGIBILITY COMMITTEE FILE . 54 96. GENERAL PRACTICE RECOGNITION APPEAL COMMITTEE FILE . 54 97. MINISTERIAL AND EXECUTIVE CORRESPONDENCE . 55 98. PRACTITIONERS UNDER NOTICE . 55 99. RESOURCE ACCESS CONTROL FACILITY USER PROFILES . 56 100. e-CERTIFICATES APPLICATION MANAGER (HAM DATABASE . 56 101. ACCOUNTS PAYABLE SYSTEM . 57 102. DEBTORS RECORDS . 57 103. ABN REPOSITORY . 58 104. FEDERAL GOVERNMENT 30% REBATES ON PRIVATE HEALTH INSURANCE . 58 105. ELECTRONIC CLAIMS .

59 106. MEDICARE SMARTCARD REGISTRATION RECORDS . 59 107. MEDICONNECT – DOCTOR REGISTRATION RECORDS . 60 108. MEDICONNECT – PHARMACY REGISTRATION RECORDS . 60 109. MEDICARE AUSTRALIA / ATO ONGOING E-TAX PREPOPULATION – POST JULY 2006 . 61 110. MEDICARE AUSTRALIA ACCESS POINT DATABASE . 61 111. MEDICARE AUSTRALIA FEEDBACK REGISTER . 62 112. LOCAL LIAISON OFFICER REGISTER . 62 113. MP/ SENATOR / ELECTORATE OFFICER REGISTER . 62

Medicare Australia. 2009 Personal Information Digest. Page 4 of 71 114. RESPITE CARE – 21 DAY EXTENSION . 63 115. AGED CARE – CLIENT RECORD (FORM 3020 . 63 116. AGED CARE – COMMUNITY AGED CARE PACKAGES CLAIM FORMS AND PAYMENT SUMMARIES . 64 117. 100 POINT CHECK . 64 118. AGED CARE – EXTENDED CARE AT HOME (EACH) CLAIM FROMS AND PAYMENT STATEMENTS . 65 119. AGED CARE – EXTENDED CARE AT HOME – DEMENTIA (EACHD) CLAIM FORMS AND PAYMENT STATEMENTS . 65 120. AUTHORISATION FORM – FOR USE BY SERVICES PARTICIPATING IN AGED CARE ONLINE CLAIMING . 65 121. AGED CARE – TRANSITIONAL CARE CLAIM FORMS AND PAYMENT STATMENTS .

66 122. APPOINTMENT OF A NOMINEE . 66 123. APPLICATION FOR ELIGIBLE OXYGEN TREATMENT AND/OR ENTERAL FEEDING SUPPLEMENT . 67 124. RESIDENT CLASSIFICATION SCALE FOR PERMANENT CARE . 67 125. RESIDENT ENTRY RECORD FOR PERMANENT CARE . 68 126. CLAIMS FOR AUSTRALIAN GOVERNMENT SUBSIDY FOR CARE RECIPIENTS IN APPROVED RESIDENTIAL CARE FACILITIES . 68 127. AGED CARE FUNDING INSTRUMENT APPLICATION FOR CLASSIFICATION . 69 128. APPENDIX 1 . 70 129. PERSONNEL RECORDS . 70

Medicare Australia. 2009 Personal Information Digest. Page 5 of 71 MEDICARE AUSTRALIA ADDRESS: PO BOX 1001 TUGGERANONG DC ACT 2901 Medicare Australia holds 127 classes of personal information. The first item listed is Personnel records, (for a description see Appendix 1 at the end of this document). Items 2 through to 127 are described individually. 1. PERSONNEL RECORDS (a) Compensation/rehabilitation records (b) Equity and diversity records (c) Staff development and training records (d) Recruitment records (e) Appeal records (against promotion and transfer) (f) Payroll and leave records (g) Aurion human resource management and payroll system (h) Personal files (i) AWA agreements (j) Counselling and discipline matters (k) Complaints and grievances (l) Documents/files created for the purposes of managing legal processes eg.

AAT, AIRC cases (m) Conflict of interest declarations (n) Performance management records See Appendix 1 for a generic description of Personnel Records. 2. OUTSIDE EMPLOYMENT APPLICATIONS The purpose of these records is to record applications for outside employment for Medicare Australia employees. Content may include name, occupation and the type of work undertaken outside of Medicare Australia. The personal information on these records relates to employees.

The following agency staff have access to this personal information: All Employment Services staff from APS 3 – EL2 and the Manager, HR Management and Development Branch. The records are kept for 75 years after the date of birth of the employee or 7 years after last action, whichever is the later. This information is not usually disclosed to other persons or organisations. Individuals can obtain information regarding access to their personal information by contacting: National Payroll Manager, National Office – (02) 6124 6569 Manager Employment Services, National Office – (02) 6124 6658 HR Manager, WA – (08) 8214 8304 HR Manager, VIC – (03) 9605 7050 HR Manager, SA – (08) 8274 9336 HR Manager, QLD – (07) 3004 5376 HR Manager, NSW – (02) 9895 3014 HR Manager, TAS – (03) 6125 5688 The records relate to 77 individuals as at 30 June 2009 and are kept on paper media.

Location: National Office and State Headquarters. Main location: National Office, 134 Reed Street North, Greenway, ACT 2900.

3. SEPARATION QUESTIONNAIRES The purpose of these records is to record the reason for separation of employment from Medicare Australia.

Medicare Australia. 2009 Personal Information Digest. Page 6 of 71 Content may include: name, occupation, gender and the reasons for separation of employment from Medicare Australia. The personal information on these records relates to employees. The following agency staff have access to this personal information: all Employment Services staff from APS3-EL2, all People and Strategy and Consultancy staff from APS6 – EL2, and the Manager, Human Resource Management and Development Branch.

The records are kept for 75 years after date of birth of employee or 7 years after last action, whichever is the later. This information is not usually disclosed to other persons or organisations.

Individuals can obtain information regarding access to their personal information by contacting: National Payroll Manager, National Office – (02) 6124 6569 Manager Employment Services, National Office – (02) 6124 6658 HR Manager, WA – (08) 8214 8304 HR Manager, VIC – (03) 9605 7050 HR Manager, SA – (08) 8274 9336 HR Manager, QLD – (07) 3004 5376 HR Manager, NSW – (02) 9895 3014 HR Manager, TAS – (03) 6125 5688 The records relate to 973 individuals as at 30 June 2009 and are stored on computer and paper media. Location: Main location: National Office, 134 Reed Street North, Greenway, ACT 2900.

Computer records are accessed via computer terminal in Payroll Team.

4. PROGRAM REVIEW DIVISION FILES The purpose of these records is to maintain a record of correspondence and information in respect of medical practitioners, allied health providers, dentists, pharmacists and patients collated during the process of investigation, audit, education, counselling and/or recoveries. In addition, records are also held for GP practices, Private Health funds and Medical Indemnity Insurers. Content may include: name, address, date of birth, occupation, gender, qualifications and any other information determined relevant by qualified officers.

Sensitive content may include: physical or mental health, disabilities, racial or ethnic origin, criminal convictions, criminal intelligence, financial information, relationship details, evidence or allegations of professional relationships and claims information.

The personal information on these records relates to medical practitioners, dental practitioners, pharmacists, optometrists and persons enrolled in the Medicare and PBS programs who have been the subject of or identified in relation to an audit or inquiry.

The following agency staff have access to this personal information: authorised staff of the Program Review Division and the Freedom of Information Officer. The records are kept for up to 10 years in accordance with RA 20174. This information is not usually disclosed to other persons or organisations other than in the pursuit of program integrity cases. In these cases the information may be referred to Commonwealth Director of Public Prosecutions or State law enforcement or review authorities through the Information Release Delegate. Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer Ph: (02) 6124 6333.

The records relate to a large number of individuals and are stored on computer and paper media.

Medicare Australia. 2009 Personal Information Digest. Page 7 of 71 Location: National Office and State Headquarters hold paper records; computer records are accessed via computer terminals within Medicare Australia network. Main location: National Office, 134 Reed Street North, Greenway, ACT 2900. 5. COMMITTEES AND TRIBUNAL FILES The purpose of these records is to enable Medicare Australia to carry out its Committee and Tribunal secretariat functions. Content may include: name, address, date of birth and gender.

Sensitive content may include: physical or mental health, criminal convictions, financial information, clinical conditions, services rendered and medication dispensed.

The personal information on these records relates to Committee or Tribunal members, specific medical or dental practitioners, optometrists, chiropractors physiotherapists, podiatrists, osteopaths, pharmacists, and patients. The following agency staff have access to this personal information: Chief Executive Officer, Deputy Chief Executive Officers, General Manager Program Review Division, authorised staff of Program Review Division and authorised Secretariat staff. The records will be retained permanently in accordance with RA 20157. Some of this information is disclosed to: the Minister for Human Services, the Minister for Health and Ageing and members of the relevant Committees and Tribunals.

Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer Ph: (02) 6124 6333. The records are stored on computer and paper media. Main location: National Office, 134 Reed Street North, Greenway, ACT 2900. 6. INVESTIGATIONS INFORMATION FILES SYSTEM The purpose of these records is to provide and collate information to facilitate the protection and control of Commonwealth revenue allocated to the Medicare and Pharmaceutical Benefits Scheme. Content may include: name, address, date of birth, gender, personal identification number, Medicare card number, PBS entitlement number(s), pharmacy approval number, practice locations, qualified specialty and provider number.

Sensitive content may include: physical or mental health, disabilities, identified illegal immigrants, Medicare and/or PBS criminal convictions, Medicare and/or PBS benefit recoveries, details of known professional relationships (practitioner/pharmacist) and company directorships (practitioner/pharmacist), known fraudulent identities and details of unusual Medicare or PBS claiming or servicing patterns, if any. No patient clinical details are stored. The personal information on these records relates to persons enrolled in the Medicare and/or PBS programs and providers of services for which Medicare and/or PBS benefits are payable and in respect of whom some inquiry and/or post payment action has been initiated.

The following agency staff have access to this personal information: authorised staff of Program Review Division and the Freedom of Information Officer. The records are kept indefinitely and appraised before destruction as required under the Archives Act 1983. This information is not usually disclosed to other persons or organisations. Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer Ph: (02) 6124 6333. The records relate to approximately 43,000 individuals and are stored on computer media.

Medicare Australia.

2009 Personal Information Digest. Page 8 of 71 Note: The Investigations Information Files System is now only a data base holding and is not actively updated, it is a legacy system for simple antecedent/background checks. Location: Computer records are accessed via computer terminals within Medicare Australia network. Main location: National Office, 134 Reed Street North, Greenway, ACT 2900. 7. PROGRAM REVIEW DIVISION – GENERAL CORRESPONDENCE The purpose of these records is to record general correspondence with practitioners and pharmacists in regard to servicing, and members of the public in regard to fraud and involvement in inappropriate practice and matters relating to recoveries.

Content may include: name, address, occupation, practice location, pharmacy location, qualifications, institution through which qualifications were obtained and other details volunteered by individuals. Sensitive content may include: physical or mental health, criminal convictions, details of medical practice and details of pharmacy. The personal information on these records relates to members of the medical, pharmacy and optometrical professions and members of the public. The following agency staff have access to this personal information: authorised staff of Program Review Division and its state office counterparts and the Freedom of Information Officer.

The records are retained permanently according to RA 20169. This information is not usually disclosed to other persons or organisations. Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer Ph: (02) 6124 6333. The records relate to a large number of individuals and are stored on paper media. Location: National Office, 134 Reed Street North, Greenway, ACT 2900. 8. NATIONAL INTELLIGENCE SYSTEM The purpose of these records is to identify fraud and inappropriate practice in the programs administered by Medicare Australia.

Content may include: name, address, Medicare card number, Centrelink number, Department of Veterans’ Affairs number, safety net entitlement number and date of birth, pharmacy approval number, pharmacy address, prescriber number, and prescriber location. Content may also include: name, address, date of birth, occupation, gender, summary statistics on utilisation of services and benefits paid in the programs administered by Medicare Australia. Sensitive content may include: physical or mental health, disabilities, criminal intelligence and financial information. The personal information on theses records relates to Medicare or PBS patients.

The following agency staff have access to this personal information: appropriately cleared staff in the Program Review Division. The records are retained until the investigation and follow up is complete. The records are kept for 10 years in accordance with RA 20174. This information is not usually disclosed to other persons or organisations. Individuals can obtain information regarding access to their personal information by contacting: the Freedom of Information Officer, Ph: (02) 6124 6333. The records relate to approximately 500,000 individuals as at 30 June 2009 and are stored on computer media.

Location: National Office, 134 Reed St North, Greenway ACT 2900.

Medicare Australia. 2009 Personal Information Digest. Page 9 of 71 9. AUSTRALIAN CRIMES COMMISSION (ACC) FALSE IDENTITY DATABASE The purpose of these records is to identify fraud and inappropriate practice in the programs administered by Medicare Australia, where this inappropriate activity has been undertaken by individuals known to the Australian Crime Commission as false or fraudulent identities. Content may include: name, address, date of birth and gender. Sensitive information may include: fraudulent identities known to the Australian Crime Commission. The personal information on these records relates to individuals (both false and real) and includes aliases.

The following agency staff have access to this personal information: authorised staff of the Program Review Division. These records are retained permanently.

This information is classified by the Australian Crime Commission and is not disclosed to any other person or organisation. This information is the subject of an inter-agency agreement between the ACC and Medicare Australia. Individuals can obtain information regarding access to their personal information by contacting the ACC. The records relate to approximately 6500 individuals as at 30 June 2009 and are stored on computer media. Location: National Intelligence System, National Office – 134 Reed St North, Greenway, ACT 2900 10. PROJECT INFORMATION MANAGEMENT SYSTEM The purpose of these records is to protect and control Commonwealth revenue allocated to the Medicare and PBS programs, and to record information relating to projects undertaken by the Program Review Division.

Content may include: file number, name, address, provider number, pharmacy approval number and nature of inquiry. Sensitive content may include: criminal convictions, criminal intelligence and financial information. The personal information on these records relates to providers of medical services for which Medicare and PBS benefits are payable and about whom Medicare Australia has undertaken a routine review or inquiry. The following agency staff have access to this personal information: authorised staff of Program Review Division and its State Office counterparts and the Freedom of Information Officer.

The records are kept permanently in accordance with RA 20167. This information is not usually disclosed to other persons or organisations. Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer Ph: (02) 6124 6333. The records relate to approximately 17,000 individuals and are stored on computer and paper media. Note: The Project Information Management System is now only a data base holding and is not actively updated, it is a legacy system for simple antecedent/background checks. Location: National Office and State Headquarters hold paper records; computer records are accessed via computer terminals within Medicare Australia network.

Main location: National Office, 134 Reed Street North, Greenway, ACT 2900.

11. INVESTIGATORS’ AND MANAGERS’ DIARIES. The purpose of these records is to record daily professional activities. Content may include: name, address, date of birth and phone number.

Medicare Australia. 2009 Personal Information Digest. Page 10 of 71 The personal information on these records relates to practitioners, pharmacists, patients, staff and members of the public. The following agency staff have access to this personal information: diary owner and their supervisor, Executive Assistant and the Freedom of Information Officer. Diaries are the property of Medicare Australia and are redeemable on cessation of employment with the organisation.

The records are kept indefinitely and will be appraised before destruction as required under the Archives Act 1983. This information is not usually disclosed to other persons or organisations.

Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer Ph: (02) 6124 6333. The records relate to an unknown number of individuals and are stored on paper media. Location: National Office and State Headquarters. Main location: National Office, 134 Reed Street North, Greenway, ACT 2900. 12. PROVIDER MONITORING SYSTEM The purpose of these records is to provide and collate information to facilitate the protection and control of Commonwealth revenue allocated to the Medicare program and to record details relating to interventions by staff of the Program Review Division.

Content may include: name, address and occupation. Sensitive content may include: financial information and details of interventions. The personal information on these records relates to providers of medical services for which Medicare benefits are payable and about whom Medicare Australia has undertaken an inquiry and intervened. The following agency staff have access to this personal information: authorised staff of Program Review Division, its state office counterparts and the Freedom of Information Officer.

The records are kept permanently in accordance with RA 20167. This information is not usually disclosed to other persons or organisations.

Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer Ph: (02) 6124 6333. The records relate to approximately 4,400 individuals and are stored on computer media. Note: The Provider Monitoring System is now only a data base holding and is not actively updated, it is a legacy system for simple antecedent/background checks.

Location: Computer records are accessed via computer terminals within Medicare Australia network. Main location: National Office, 134 Reed Street North, Greenway, ACT 2900. 13. PRISM DATABASE The purpose of this database is to maintain a record of people and organisations that are our clients, these clients are associated to Program Review activities. Content may include name, address, date of birth, occupation, gender, date of death, status, medical specialty, identification and contact details. Sensitive content may include racial or ethnic origin, criminal intelligence and financial information.

Medicare Australia. 2009 Personal Information Digest. Page 11 of 71 The personal information on these records relates to employees, practitioners, pharmacists, pharmacies, medical practice staff, members of the public, approved persons, approved pathology providers and approved pathology authorities. The following agency staff have access to this personal information: All Program Review Division staff as required. The records are kept permanently in accordance with RA 20167. Some of this information is disclosed to Freedom of Information (FOI) requesters, statistics to Attorney-General’s Department and Australian National Audit Office.

Individuals can obtain information regarding access to their personal information by contacting Program Review Division on (02) 6124 4113 or the Freedom of Information Officer Ph: (02) 6124 6333. The records relate to approximately 90,000 individuals and are stored on computer media. Location: Medicare Australia Mainframe, National Office, 134 Reed Street North, Greenway, ACT 2900. 14. PHARMACEUTICAL BENEFITS INFORMATION SYSTEM REPORTS The purpose of these records is to aid in the analysis of the use of the Pharmaceutical Benefits Scheme. The reports utilise information received from pharmacists, practitioners with authority to prescribe or via online claiming for PBS, CTS or manual claims.

Aggregated data may also be used for research purposes. Content may include: name, address, Medicare card number, Centrelink number, Department of Veterans’ Affairs number, safety net entitlement number and date of birth, pharmacy approval number, pharmacy address, prescriber number, and prescriber location.

Sensitive content may include: interpolations and extrapolations that may be made from the prescription and/or supply of PBS medications. The personal information on these records relates to: medical practitioners, participating dental practitioners, optometrists, pharmacists and all persons who received pharmaceutical benefits where there is a claim made on the Commonwealth or the Department of Veterans’ Affairs. The following agency staff have access to this personal information: authorised staff of the Pharmaceutical Benefits Branch, PBS & Aged Care Programs Division, authorised staff of the Program Review Division, authorised staff of the Information Technology Services Division and authorised staff of Legal, Privacy and Information Services Branch.

The report records are kept for varying periods (according to RA 20157/20161) depending on the nature and outcome of the report, since the report or abstracts may result in submissions to change benefits or policy or procedures, or education, or counselling, or prosecution and/or recovery of benefits paid.

This information is not usually disclosed to other persons or organisations unless release of information has been properly authorised. Individuals can obtain information regarding access to their personal information by contacting the General Manager, Program Review Division Ph: (02) 6124 6590 or the Freedom of Information Officer Ph: (02) 6124 6333. The records relate to a variable number of individuals dependent on the nature of the report and the purpose for which it was created and are stored on paper media or by electronic means.

Location: National Office and State Headquarters.

Main location: National Office, 134 Reed Street North, Greenway, ACT 2900. 15. NATIONAL ASSESSMENT The purpose of these records is to identify fraud and inappropriate practice in the programs administered by Medicare Australia. Content may include: name, address, date of birth, occupation, gender, summary statistics on utilisation of services and benefits paid in the programs administered by Medicare Australia.

Medicare Australia. 2009 Personal Information Digest. Page 12 of 71 Sensitive content may include: financial information and practice details on services used and benefits claimed. The personal information on these records relates to: practitioners, patients, receptionists, nurses, paramedics and health companies. The following agency staff have access to this personal information: all authorised staff that have a need to access the information in Program Review Division. The records are kept for a period of 10 years in accordance with RA 20174. This information is not usually disclosed to other persons or organisations.

Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer Ph: (02) 6124 6333.

The records relate to a variable number of individuals dependent on the nature of the report and the purpose for which it was created. They are stored on paper media or by electronic means. Location: National Office, 134 Reed Street North, Greenway, ACT 2900. 16. PROFESSIONAL SERVICES REVIEW SCHEME The purpose of these records is to enable the General Manager, Program Review Division or Delegates of the CEO to make requests to the Director of Professional Services Review, under s86 of the Health Insurance Act 1973. Content may include: name, address, date of birth, occupation.

Sensitive content may include criminal convictions or financial information.

The personal information on these records relates to: Medicare practitioners and patients. The following agency staff have access to this personal information: General Manager Program Review Division, authorised staff of the Program Review Division and state office counterparts. The records are retained for 10 years in accordance with RA 20174. Some of this information is disclosed to: the Director of Professional Services Review, Professional Services Review Committees, Professional Services Review Committees Secretariat and the Determining Authority. Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer Ph: (02) 6124 6333.

The records relate to approximately 670 individuals as at 30 June 2009 and are stored on paper and computer media. Location: National Office, 134 Reed Street North, Greenway, ACT 2900. 17. PROGRAM REVIEW INFORMATION FORM The purpose of these records is to protect and control Commonwealth revenues allocated to the programs administered by Medicare Australia and to record information received from a number of sources where concerns are expressed regarding the correct operation of such programs. Content may include name, address, phone numbers, practitioner, pharmacist, patient. Sensitive content may include complainant details, details of patient’s care.

The personal information on these records relates to providers of services for which Medicare and/or PBS benefits are payable and to patients who receive such services.

The following agency staff have access to this personal information: authorised staff of the Program Review Division and the Freedom of Information Officer. The records are kept in accordance with RA 20173.

Medicare Australia. 2009 Personal Information Digest. Page 13 of 71 The information is not usually disclosed to other persons or organisations. Individuals can obtain information by contacting the Freedom of Information Officer ph: (02) 6124 6333. The records relate to approximately 25,000 individuals as at 30 June 2009 and are stored on computer media.

Note: The Program Review Information Form is not actively updated, it is a legacy system for simple antecedent/background checks. Location: National Office and State Offices have access to records via computer terminals within Medicare Australia network. Main location: National Office, 134 Reed Street North, Greenway, ACT 2900. 18. PRESCRIPTION SHOPPING PROJECT NATIONAL APPLICATION The purpose of these records is to conduct the Prescription Shopping Project in line with the Medicare Australia (Functions of Chief Executive Officer) Direction 2005.

Content may include: Medicare number, patient ID, details of PBS items obtained, details of doctors and pharmacists associated with the items obtained. The personal information on these records relates to persons who meet the legislative criteria in the definition of a ‘Prescription Shopper’ and referred to as identified patients. The following agency staff have access to this personal information: designated Prescription Shopping Project staff. The records are kept for three months during analysis and identification. They are also available from archive for up to five years as data is PBS claims data.

Some of this information is disclosed to practitioners of the identified patients. Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer ph: (02) 6124 6333. The records on identified patients are stored on paper and computer media. Location: Medicare Australia network, Main location: National Office, 134 Reed Street North, Greenway, ACT 2900. 19. PRESCRIPTION SHOPPING INFORMATION SERVICE APPLICATION The purpose of these records is to conduct the Prescription Shopping Project telephone enquiry service in line with the Medicare Australia (Functions of Chief Executive Officer) Direction 2005.

Content may include: Medicare number, patient ID, address details, details of PBS items obtained, number of doctors associated with the items obtained. The personal information on these records relates to persons who meet the legislative criteria in the definition of a ‘Prescription Shopper’ and referred to as identified patients. The following agency staff have access to this personal information: designated Brisbane call centre staff, Prescription Shopping Project trained staff. The records are kept for one month. They are also available from archive for up to five years as the data is PBS claims data.

Some of this information is disclosed to Doctors of the identified patients. Information, which is disclosed to doctors, is stored on hard copy files and computer media. Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer, Ph: (02) 6124 6333. Location: Medicare Australia network, Main location: National Office, 134 Reed Street North, Greenway, ACT 2900.

Medicare Australia. 2009 Personal Information Digest. Page 14 of 71 20. PRESCRIPTION SHOPPING INFORMATION SERVICE (PSIS) DOCTOR REGISTRATION DATABASE In order to access information through the PSIS, doctors need to complete and sign a registration form and obtain an access number.

The information is held on hard copy files and computer media. The purpose of these records is to enable call centre operators to verify callers prior to disclosing information, and record call history. The information contained in the registration database includes doctor provider number, prescriber number, where qualified, year of birth, contact details, call history including patient ID.

As at 29 June 2009, the database contains details of 25,415 doctors who have registered to use the service. Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer, Ph: (02) 6124 6333. Location: Medicare Australia network, Main location: National Office, 134 Reed Street North, Greenway, ACT 2900. 21. CENTRELINK DISABILITY SUPPORT PENSION DATABASE The purpose of these records is to identify by data-matching, those living Centrelink clients in receipt of a disability support pension who may have or be deliberately defrauding either Centrelink, Medicare Australia or both, by either creating false identities, obtaining benefits by deception or otherwise obtaining benefits to which they are not entitled.

Content may include name, address, date of birth and gender.

The personal information contained in these records relates to all living Centrelink Disability Support Pension customers including overseas, suspended and cancelled customers as at 21 January 2008. The following agency staff have access to this personal information; authorised staff within the Program Review Division.. These records will be kept until the project is completed. Some of this information is disclosed to the originating agency, Centrelink. Specifically the Fraud Intelligence Section. These records relate to 1,103,153 individuals and are stored on computer media.

Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer Ph: (02) 6124 6333.

Location: National Office, 134 Reed Street North, Greenway, ACT 2900. 22. CENTRELINK IDENTITIES The purpose of these records is to store the Customer Registration Details for Centrelink. Content may include name, date of birth, Centrelink Reference Number (CRN) and relationship type. The personal information contained in these records relates to members of the public and fraudulent activities. The following agency staff have access to this personal information: Staff members who have a Protected Security Clearance and have access to the National Intelligence Facility.

These records are retained permanently. These records are stored on computer media and are not usually disclosed to other persons or organisations. The current volume of records is approximately 21 million as at 20 June 2009.

Medicare Australia. 2009 Personal Information Digest. Page 15 of 71 Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer Ph: (02) 6124 6333. Location: National Office, 134 Reed Street North, Greenway, ACT 2900. 23. NATIONAL INTELLIGENCE – CUSTOMS The purpose of these records is to hold information which has been supplied by Customs about one of their operations which has resulted in the seizure of Medicare related information.

Content may include name, address, date of birth and information related to the seizure that is relevant to Medicare Australia. Sensitive content may include criminal intelligence. The personal information contained in these records relates to individuals who have had property seized by Customs. The following agency staff have access to this personal information: only those who have a Protected Security Clearance and have access to the National Intelligence Facility. These records are retained permanently.

These records are stored on computer media and are not usually disclosed to other persons or organisations.

These records relate to 27 individuals as at 30 June 2009. Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer Ph: (02) 6124 6333. Location: National Office, 134 Reed Street North, Greenway, ACT 2900. 24. UNAUTHORISED ACCESS DATABASE The purpose of these records is to identify unauthorised access to the information held in the programs administered by Medicare Australia Content may include: name, address, Medicare card number, date of birth, provider number, and provider location. Sensitive content may include: criminal intelligence information.

The personal information contained on these records relates to employees of Medicare Australia and individuals enrolled in the Medicare program. The following agency staff have access to this personal information: appropriately cleared staff in the Audit and Rish Assurance Branch, Privacy and Information Release Branch and IT Security. These records are retained for 7 years and/or until the investigation and/or possible follow up is completed. This information may be disclosed to other organisations for the purpose of conducting further investigations. The records relate to approximately 948 individuals as at 30 June 2009 and are stored on computer media.

Individuals can obtain information regarding access to their personal information by contacting the Branch Manager of the Audit and Risk Assurance Section (ARAS) Ph: (02) 6124 7703 or the Freedom of Information Officer, Ph: (02) 6124 6333.

Location: National Office, 134 Reed St North, Greenway ACT 2900. 25. UNAUTHORISED ACCESS CASE FILES The purpose of these records is to keep track of potential and proven cases of unauthorised access to the information held in programs administered by Medicare Australia.

Medicare Australia. 2009 Personal Information Digest. Page 16 of 71 Content may include: name, address, Medicare card number, gender, date of birth, staff ID number and details of individuals accessed. The personal information contained on these records relate to employees of Medicare Australia and individuals enrolled in the Medicare program.

The following agency staff have access to this personal information: appropriately cleared staff of the Audit and Risk Assurance Branch, Privacy and Information Release Section and IT Security.

These records are retained for 10 years or until the investigation and follow up is complete. This information may be disclosed to other organisations for the purpose of conduction further investigations. The records relate to approximately 948 staff members as at 30 June 2009 and are stored on computer and paper media. Individuals can obtain information regarding access to their personal information by contacting the Branch Manager of the Audit and Risk Assurance Section (ARAS) Ph: (02) 6124 7399 or the Freedom of Information Officer, Ph: (02) 6124 7789.

Location: National Office, 134 Reed St North, Greenway ACT 2900.

26. UNAUTHORISED ACCESS EXTRACTION FILES The purpose of these records is to assist with identifying unauthorised access to the information held in the programs administered by Medicare Australia. Content may include: name, address, Medicare card number, safety net entitlement number, date of birth, provider number and address, occupation, gender and summary statistics on utilisation of services and benefits paid. Sensitive content may include: sensitive medical information and financial information. The personal information contained on these records relate to employees of Medicare Australia and individuals enrolled in the Medicare program.

The following agency staff have access to this personal information: appropriately cleared staff of the Audit and Risk Assurance Branch, Privacy and Information Release Section and IT Security. These records are retained for 10 years or until the investigation and follow up is complete. This information is not usually disclosed to other organisations. It is not possible to provide an accurate or approximate number of records held on these files as potentially all persons enrolled on the Medicare program could have information on these files. This information is stored on computer media.

Individuals can obtain information regarding access to their personal information by contacting the Branch Manager of the Audit and Risk Assurance Section (ARAS) Ph: (02) 6124 7399 or the Freedom of Information Officer, Ph: (02) 6124 7789.

Location: Computer terminal in the Unauthorised Access and IT Security areas. National Office, 134 Reed St North, Greenway ACT 2900. 27. MEDICARE INFORMATION SYSTEM REPORTS The purpose of these records is to aid in the statistical analysis of Medicare use. The reports utilise information from the Medicare provider file, the Medicare claims history records and the Medicare enrolment records. Aggregated data may be used for research purposes.

Content may include: name, address, date of birth and gender. Sensitive content may include: physical or mental health, disabilities, racial or ethnic origin, financial information, relationship details, Medicare claims history and patient history, Private Health Insurance Advisory Committee (PHIAC) record and/or financial information of the billing agents.

Medicare Australia. 2009 Personal Information Digest. Page 17 of 71 The personal information on these records relates to persons enrolled in the Medicare program and eligible service providers. The following agency staff have access to this personal information: General Managers, senior State management; authorised staff of the Program Review Division and its State office counterparts; authorised staff of the Public and Provider Services Division, Medicare and AGP Division, PBS and Aged Care Division, Financial Management Group, PHIAC Officer, and relevant State Office staff.

The report records are kept for varying periods depending on the nature and outcome of the report. This information is not usually disclosed to other persons or organisations. Individuals can obtain information regarding access to their personal information by contacting the Freedom of Information Officer Ph: (02) 6124 6333. The records relate to a variable number of individuals dependent on the nature of the report and the purpose for which it was created, and are stored on paper media. Location: National Office and State Headquarters. Main location: National Office, 134 Reed Street North, Greenway, ACT, 2900.

28. MEDICARE PUBLIC ENROLMENT RECORDS The purpose of these records is to enrol and identify eligible persons for the purpose of administering the Medicare program. Content may include: name, address, date of birth, gender, country of origin, travel documents, copies of passports, copies of Birth Certificates, entitlement start and end dates, residency status, telephone number, Medicare card number, personal identification number, consumer number, indigenous identifier, email address, fax numbers and bank account details.

Sensitive content may include: origin and indigenous status. The personal information on these records relates to persons enrolled in or who have applied for the Medicare program.

The following agency staff have access to this personal information: authorised Medicare operational staff; authorised staff of the Medicare and AGP Division, PBS and Aged Care Division, Program Review Division, Public and Provider Services Division and the Freedom of Information Officer. The records are kept in two forms, which are retained for different periods. Generally, paper enrolment forms and accompanying documentation are held for two years and then destroyed in accordance Records Authority Entry 20163; electronic records held in the Consumer Directory System are not authorised for disposal in accordance with Records Authority Entry 20204.

. Some of this information is disclosed to: the Department of Human Services, the Department of Health and Ageing, the Department of Families, Housing and Community Services and Indigenous Affairs, the Department of Immigration and Citizenship and the Department of Veterans' Affairs. Individuals can obtain information regarding access to their personal information by contacting: the Freedom of Information Officer on (02) 6124 6333. Limited personal information is available over the counter at a Medicare office or by telephone after proper identification.

The records relate to approximately 21 million individuals and are stored on computer and paper media.

Location: Paper records are held in National Office and State Headquarters. Computer records are accessed via computer terminals within Medicare Australia network. Main location: National Office, 134 Reed Street North, Greenway, ACT 2900. 29. MEDICARE AND DVA PROVIDER REGISTRATION RECORDS

Medicare Australia. 2009 Personal Information Digest. Page 18 of 71 The purpose of these records is to identify eligible providers and prescribers, and to record their qualifications and status for the payment of Medicare benefits and Repatriation benefits. Content may include: name, address, year of birth, occupation, gender, practice location, graduation dates and places, practitioner registration number issued by registering authority, residency status, languages spoken, vocational recognition status, Fellowship, provider number, prescriber number, telephone number and email address. The personal information on these records relates to medical practitioners, participating dental practitioners, participating optometrists, aboriginal health workers, audiologists, chiropodists, chiropractors, diabetes educators, dieticians, exercise physiologists, mental health nurse, occupational therapists, osteopath, physiotherapists, podiatrists, psychologists and speech pathologists.

The following agency staff have access to this personal information: authorised staff of the Medicare and AGP Division, Program Review Division, Chief Operating Officer Division and their state office counterparts; the Freedom of Information Officer; and authorised staff of the Financial Management Group. Paper records are kept for a period of 25 years after last action completed in accordance with Records Authority Entry 20167. Electronic records in the Provider Directory System are not authorised for disposal in accordance with Records Authority Entry 20204.

Some of this information is disclosed to: the Department of Human Services; the Department of Health and Ageing; the Department of Veterans' Affairs; authorised external recipients including private health insurance funds; public hospitals and pathology laboratories; the Royal Australian College of General Practitioners; the Australian College of Rural and Remote Medicine; and the Office of Hearing Services.

Individuals can obtain information regarding access to their personal information by contacting the Manager, Medicare and VAP Branch; Medicare Provider Services Operations Manager or the Freedom of Information Officer Ph: (02) 6124 6333.

The records relate to approximately 165,000 individuals and are stored on computer, paper and microfiche media. Location: National Office and State Headquarters hold Paper and microfiche records; computer records are accessed via computer terminals within Medicare Australia network. Main location: National Office, 134 Reed Street North, Greenway ACT 2900. 30. MEDICARE BENEFITS ADVISORY COMMITTEE APPLICATIONS AND DETERMINATIONS The functions of the Committee are to consider references to it by the Minister for Health and Ageing under sections 19A and 3C of the Health Insurance Act 1973 relating to whether Medicare benefits should be payable for a particular procedure or treatment.

Due to the repeal of sections 11 and 12 a new panel has been formed under the title of the Medicare Claims Review Panel (MCRP) which was established to look at plastic surgery services and services performed in excess of item limits. Content may include: name, address, date of birth, gender, telephone number (work/home), Medicare card number, practitioner's provider and/or prescriber number. Sensitive content may include: physical or mental health, disabilities, medical history and information as volunteered by the practitioner and/or patient.

The personal information on these records relates to Medicare enrolees upon whom either plastic surgery services are performed or services are performed in excess of item limits or are proposed to be performed and to the practitioners who have /or will render the services.

The following agency staff have access to this personal information: authorised staff of the Medicare and Associated Government Program Division and its State office counterparts; authorised staff of the Program Review Division and its State office counterparts; and senior management.

These records are retained permanently in accordance with RA 20157. Some of this information is disclosed to: members of the MCRP, as well as the Schedule Review Section of the Department of Health and Ageing.