Health Payments Integrity Team (HPIT) of Te Whatu Ora / Health New Zealand is commencing a PHO data matching project in June. Approximately 710,000 new patients have enrolled with a PHO in Aotearoa since the last PHO eligibility data matching project was completed in 2018.
Those 710,000 records will be checked against Immigration New Zealand records to identify patients who are not eligible for subsidised health care, either because they are ineligible or have been out of New Zealand for a continuous period of more than 12 months.
Preliminary 2023 data results indicate Te Whatu Ora will contact about 10,000 patients across the motu (country) to determine if they are eligible or should be removed from PHO Registers. Each person will have the opportunity to establish their eligibility.
Pinnacle MHN will receive a list of individuals who have been identified as ineligible, and we will work with the relevant practices to remove them from future enrolment registers before the next submission.
If a PHO does not remove an ineligible person from the enrolment register and continues to submit the ineligible person on future enrolment registers for funding, it could result in a formal audit of the PHO register, and where applicable, may lead to the recovery of any overpayment. HPIT will monitor registers submitted after notification to confirm ineligible individuals have been removed.
HPIT will monitor registers submitted after notification to confirm ineligible individuals have been removed.
Please contact Katie Latimer, Pinnacle general manager - strategic development (details below) with any questions or concerns and we will raise them with Te Whatu Ora.
Katie Latimer, General Manager - Strategic Development
Katie.Latimer@pinnacle.health.nz
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