DoHAC targets four areas in new compliance activity

Jolyon Attwooll

18/01/2024 4:06:48 PM

Around 100 GPs will receive letters for high MBS activity in areas including timed professional services and chronic disease management.

Person reading letter
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
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Dr John Anthony Crimmins   19/01/2024 9:05:07 AM

These letter will list patient services provided that the Dept sees as being provided inappropriately and in all cases the money is refunded despite the GP explanation.
Ask the many GPs who had to go through a similar 'educational and co operative" process in the past.
This is basically paying lip service as unless you get 100% on MBS compliane and accept how the dept interprets the descriptor you are gone.
Lets hear back from the 100 getting letters. Then run the story-otherwise this is just a fluff piece.

Dr Rama Krishnan   19/01/2024 9:35:37 AM

I presume the same monitoring will be applied to specialists too. I presume another 100 letters will be sent to specialists also from the department of health. Or the specialists are lily white and only the GPs indulge in fraudulent practices??

Dr Colin Scott Masters   19/01/2024 10:03:24 AM

The letters would be useful if they were interactive ie the people receiving them could ask questions about interpretation of the item numbers in question. For instance give some examples of how and why they use the MBS item number and hurt feedback on whether the Department feels that is acceptable

In the past whenever you try and nail down what is acceptable use of an item number the Department shifts responsibility very quickly eg “what ever is acceptable to your peers OR check with your college etc Round and round we go

Dr Li-Chen Zhang   19/01/2024 8:48:36 PM

Would these physicians be targeted too? A lot of specialist: endocrinologist, respiratory physicians, they use special care plan items for each patient visit them and they could do 8 cases per day. Why always only GP as a victim?

Dr Gihan de Mel   21/01/2024 7:48:04 AM

It's truly sad to see a barrage of what they call "nudge letters" sent to the most hardworking GPs. The theory behind these seems to be a subtle push towards compliance, but the evidence supporting their effectiveness is questionable at best. We know that blame, punishment, and fear rarely lead to genuine improvement in workplace culture.
In the complex world of healthcare, where our GPs work tirelessly to provide the best possible care, it's disheartening to see a strategy that might catch a 2 or 3 wrongdoers but risks demoralising the majority. Positive reinforcement, autonomy, and intrinsic motivation are proven to be more effective in bringing about lasting change.
If you are a hard-working GP, please know that your commitment is highly appreciated and celebrated, and the focus should be on acknowledging the diverse nature of general practice and supporting the most vulnerable patients rather than sending frustrating #Robodebt letters.