Centrelink has human touch with Medicare data initiative, department says

Human Services data-matching informs manual investigations

The Department of Human Services has indicated that a program that involving Centrelink matching Medicare’s data holdings to its own records of welfare claimants to find evidence of fraud or identity theft will has a role for human analysts.

A previous data-matching initiative involving Centrelink accessing Australian Taxation Office (ATO) data to find evidence of possible welfare overpayment was dubbed ‘robodebt’ by its detractors. That program, named the Online Compliance Initiative (OCI) by Centrelink, has seen hundreds of thousands of letters automatically sent out to current and former welfare recipients demanding evidence that they had not been overpaid.

Although Centrelink had previously drawn on ATO data to find evidence of overpayment, in the past it was a task performed by the agency’s personnel. Robodebt critics argued that the automated nature of the OCI letters put the onus on individuals to prove they were not overpaid.

This process of matching Medicare data to Centrelink’s own data “is not new,” Human Services general manager Hank Jongen told Computerworld.

“We are enhancing the already established data sharing arrangements between Centrelink and Medicare to better protect people from identity crime.”

“The misuse of identity information for fraud and criminal purposes causes substantial harm to the economy and individuals each year,” Jongen said in an emailed statement.

The department is pusing the enhanced data-matching program as an intelligence tool, with trained analysts expected to use it to inform their manual investigations into potential fraud or identity theft.

“This is just one of the tools we can use to detect potential fraud and matches with community expectations in allowing our two systems to ‘talk’ to each other,” Jongen said.

“Sensitive information, such as the nature of people’s medical services, is excluded from this process.”

“The purpose of this activity is to discover individuals who are not recorded as having experienced a series of expected ‘life events’ across both programs,” the program description states.

“Where expected life events have not occurred this may highlight high-risk identities and the need for further analysis to determine possible fraudulent behaviour and/or record correctness.” 

The document states that matters “that do not meet the fraud investigation selection criteria (or do not progress as investigations for other reasons) but may require some corrective treatment, will be referred to the relevant business areas for appropriate intervention.”

“These business areas have responsibility for notifying the individual of any discrepancies and providing the individual with an opportunity for record correction,” states the document published earlier this month, which outlines the protocol for the program.

“Administrative action may include the reduction, suspension or cancellation of benefits and also includes actions taken to recover any overpaid amounts. Any such decision will be notified to the recipient in writing together with their review rights.”

The protocol released by the department indicated that the records it obtains from Medicare include: Medicare Program Number; Medicare Identity Number;  Centrelink Customer Reference Number (CRN) / Centrelink Identity; gender; name; date of birth; date of death; address; phone number; date of medical and/or service obtained; and start and end date, if applicable.

“We voluntarily published these protocols in the interest of being transparent and to meet recommendations from the Office of the Australian Information Commissioner (OAIC),” Jongen said.

“One example of how this works is that we can identify attempted identity takeovers through our channels,” the Human Services GM said.

“We would then take action to prevent the customer from becoming the victim of identity fraud.”

“Where vulnerable or potentially exploited customers are identified the department will conduct further inquiries to ensure the customer’s wellbeing,” Jongen said.

A 2017 Senate inquiry recommended that a Human Services redesign of the OCI system include “the necessary protocols to protect vulnerable cohorts, including people experiencing mental health issues.”

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Tags medicarecentrelinkDepartment of Human ServicesMedicare Australiarobo-debt

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