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‘Early intervention letters’ sent for overseas MBS claims
Around 1100 GPs have been asked to review a schedule of claims as part of a Health Department focus on overseas billing.
Medicare benefits are only payable where the service is performed in Australia to an eligible patient, including for telehealth services.
More than 1100 GPs across Australia have received ‘early intervention letters’, as the Department of Health, Disability and Ageing (DoHDA) focusses its compliance on overseas billing.
The letters include a schedule of claims to review, all related to billing Medicare while overseas.
It comes after ‘education letters’ were sent to more than 4600 GPs last month who may have claimed a Medicare Benefits Schedule item while overseas.
Under section 10 of the Health Insurance Act 1973, Medicare benefits are only payable where the service is performed in Australia to an eligible patient, including for telehealth services.
RACGP President Dr Michael Wright told newsGP he has since followed up with DoHDA about the ‘early intervention letters’ to seek additional information.
‘This has been one of the priorities for Medicare compliance this year, but it can still be a surprise for people when they see these compliance letters,’ he said.
‘The important message for everyone who has received any of these compliance letters is that, if you are concerned, seek advice from your medical indemnity provider.’
Dr Wright said DoHDA has confirmed the letters only relate to services being billed while the doctor is overseas, and do not relate to a patient being overseas.
He added that GPs receiving only an ‘education letter’ do not need to take further action and that any incorrect billing is likely ‘low level or low value’.
‘The purpose of this letter is really to raise awareness of the rules that state that providers and patients need to be in Australia,’ Dr Wright said.
According to a recent newsGP poll, asking GPs whether they are aware of current laws stating that Medicare benefits are only payable where the service is performed in Australia, 84% of the 1496 respondents said they knew about the laws.
The letters come after the DoHDA announced its top compliance priorities for 2025 earlier this year, with other items on the list including bulk billing and raising additional charges, suspected fraud, duplicate payments, and inappropriate claiming of high-cost PBS medicines.
While the RACGP cannot intervene in individual compliance cases, Dr Wright said he wants to hear from members who have received an ‘early intervention letter’ but believe DoHDA has inaccurately identified them.
Members can email healthreform@racgp.org.au.
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