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DoHAC targets four areas in new compliance activity
Around 100 GPs will receive letters for high MBS activity in areas including timed professional services and chronic disease management.
A small number of GPs are likely to receive correspondence from the Department of Health and Aged Care.
The Department of Health and Aged Care (DoHAC) has flagged new compliance activity, with letters expected to be sent to around 100 GPs with particularly high MBS claim volumes in four separate areas.
The correspondence, which DoHAC refers to as Provider Profile Review Letters (PPRLs), is expected to focus on GPs with MBS activity that exceeds most of their peers in the following areas:
- daily services
- chronic disease management services
- timed professional attendances
- claims for multiple services for the same patient on the same day (or in association).
The templated letters, seen by
newsGP, acknowledge that MBS and PBS usage can reflect differences in location, patient demographics, special clinical interests and additional training.
DoHAC is also including details on the data used to inform the decision to send the correspondence, as well as educational information about the correct use of the MBS items cited in the letters.
According to DoHAC, compliance activity is intended to encourage health practitioners to review their claims, consider why the claiming may be higher than their peers and to self-correct if necessary.
GPs are also offered the option to acknowledge any Medicare benefit they believe may have been claimed incorrectly via a form on the DoHAC website.
RACGP President Dr Nicole Higgins says the shift in approach is one the college has long advocated for.
‘We have been working very hard to ensure the department move away from a punitive approach to an educative and supportive approach,’ she told
newsGP.
‘There’s been a lot of work explaining how general practice works on the ground, and the environment that some of these GPs are working in.’
Last year, around 600 doctors received compliance warnings over co-claiming practice nurse item 10997 and a chronic disease management (CDM) item for the same patient on the same day – a move met with
anger from many of the GPs affected.
The college has also strongly criticised previous compliance campaigns, such as a 2021 decision to send compliance letters to hundreds of GPs about new MBS telehealth claiming rules.
‘We’ve seen the devastating effect when compliance activities have been used as a blunt instrument in the past,’ Dr Higgins said.
‘It’s had a dreadful impact on the health and wellbeing of GPs and has resulted in people reducing their work hours and cutting access for patients.
‘The department’s now very aware of that and is working with us to be able to provide education and support for GPs to do things better if they need to.’
The RACGP President also said the letters are likely to affect only a very small number of GPs.
‘These activities are very targeted for the people at the absolute top of the item number usage,’ she said.
‘And it doesn’t say that they’re necessarily doing anything wrong, it’s just these are the people who use the item numbers the most.’
GPs who have questions about the issues raised or who want to respond to the letter can email pprletters@health.gov.au
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