Billing Review Program: Private investigators

Information for private investigators

As part of this, authorised WorkSafe agents and self-insurers may use private investigation firms to help determine if a person is entitled to receive compensation.

WorkSafe routinely checks the payments it makes to service providers, including private investigators.

These checks are part of our Billing Review Program (BRP) to ensure that your billing for investigative services for injured workers is reasonable and complies with our policies and fee schedules.

Why WorkSafe has a provider billing review

Through the BRP, WorkSafe conducts periodic reviews of payments made to private investigators.

The primary focus of the program is to ensure that payments made to these providers are appropriate and comply with WorkSafe policies, fee schedules and Codes of Practice. WorkSafe may review payments made at any time.

How WorkSafe notifies a provider about reviews

When seeking information and documents directly from private investigators as part of the Billing Review Program, WorkSafe may formally notify investigators of a requirement for worker information and records/documents made by them pursuant to section 552 of the Workplace Injury Rehabilitation and Compensation Act 2013.

This section provides the authority for the supply of the requested information and documents to WorkSafe.

WorkSafe also relies on the audit provisions contained in the Code of Practice for Private Investigators when requesting information and documents.

How WorkSafe requests information for reviews

WorkSafe will contact investigators about a review before a visit and arrange a time to collect the requested information and documents. Documents will be returned to you within an agreed time frame. WorkSafe may also contact other parties to obtain information and documentation, to help with the billing review.

WorkSafe aims to communicate and obtain requested information and documentation from private investigators in a co-operative way.

In some circumstances, WorkSafe also has the authority to inspect, examine or make extracts from, or copies of any information within premises that may be required to complete a billing review.

The information and documentation obtained by WorkSafe is not used for any other purpose other than the billing review.

Confidentiality and secure storage of patient information

WorkSafe is required to comply with the Information Privacy Act 2000 (Vic), the Health Records Act 2001 (Vic) and the Information Privacy Principles and Health Privacy Principles set out in those Acts.

Information collected from providers as part of the BRP is managed in accordance with WorkSafe privacy policies, and is not placed on claim files.

What is considered in a review

A WorkSafe billing review focuses on ensuring that payments made to private investigators are appropriate and comply with WorkSafe policies, fee schedules and relevant Codes of Practice.

When completing reviews, WorkSafe considers:

• billing data
• relevant policies
• fee schedules
• Code of Practice for Private Investigators provisions

WorkSafe obtains and relies on advice from appropriately qualified subject matter experts during a billing review.

Who providers deal with during reviews

If payments made to you are under review, you may receive a request for information from a representative of WorkSafe’s Enforcement Group.

How long will the review process take

The review process can take up to several months to complete depending on the time taken to collect the required information and the number of reviews being completed. WorkSafe strives to communicate and clarify any issues identified as part of the review.

Private investigators can also communicate with WorkSafe if they have any queries.

What happens at the end of the review

WorkSafe will communicate with investigators about the outcome of the review.

Potential outcomes include one or more of the following:

• no further action being taken
• an explanation being required
• reimbursement of any incorrect / inappropriate payments
• suspension or termination of your registration to provide investigation services to WorkSafe Victoria
• referral to Victoria Police

When appropriate, WorkSafe will provide investigators with practical and constructive advice about how to comply with the relevant policy and billing rules. Investigators also have a chance to respond to any findings from the review. This response will be considered when deciding the next course of action.

Payment reconciliation and self-audit

WorkSafe encourages all providers to reconcile payments with invoices and to review their billing practices relating to WorkSafe claims as a matter of course.

Investigators who discover any billing errors or incorrect billing practices in relation to services provided to injured workers should contact the relevant WorkSafe insurers. These insurers will work with them to address any issues and provide advice on how errors can be rectified.