Our client, a major player in the Australian healthcare market, engaged us to conduct a detailed Medicare billing review as part of due diligence for a potential acquisition. The target business was a large, multi-site general practice operation with over 200 GPs contributing to Medicare claims over a 12-month period.
We were tasked with analysing approximately 26,500 claim lines, valued at over $35 million, to assess billing integrity, compliance risk, and any red flags that could impact the value or viability of the acquisition.
Our review involved:
- Identifying patterns of concern or inconsistencies in billing
- Assessing potential exposure to Medicare audits or repayment liabilities
- Evaluating billing practices against legislative and policy requirements
- Providing insights into billing literacy and documentation adequacy across the provider network
This was a high-stakes, high-value engagement where the financial and reputational risks were significant. Our findings helped the client gain a clear picture of the billing environment and potential compliance liabilities.
Outcome:
Based on a combination of factors – including our findings – the client ultimately decided not to proceed with the acquisition.