GP feedback requested for compliance audit

Matt Woodley

1/11/2019 3:38:06 PM

With the Department of Health’s approach to health provider compliance under the microscope, GPs are seeking clarity to ensure they are adequately informed about their obligations.

Person closely examining financial documents.
The audit will help inform future compliance approaches.

The Australian National Audit Office (ANAO) will also examine whether the Department of Health’s (DoH) approaches to managing non-compliance are appropriate, and how the outcomes of such activities inform future compliance approaches.
Dr Michael Wright, Chair of RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), told newsGP that more clarity is required to ensure GPs are adequately informed about compliance measures and their obligations.
‘There have been increasing multiple layers of compliance and monitoring introduced into Medicare, and it’s been a concern for GPs that the processes haven’t seemed fully transparent,’ he said.
‘Some GPs have complained that they’re not quite sure what exactly the right thing is and that the advice they get from AskMBS sometimes varies.
‘That’s frustrating, but it’s also bad for patients if they’re not getting the right services, because the GP is scared to bill them.’
In July, hundreds of GPs received ‘Review and Act Now’ letters related to claiming activity for bulk bill incentive items 10990–10992, that asked recipients to review potential claiming errors for patients who were not concession card holders or not under the age of 16, but who had been billed one of the three items.
Other Medicare Benefits Schedule (MBS) items related to chronic disease management services, mental health plans, after-hours items and skin cancer items have also come under review, along with GPs who have ratios well outside those of their peers.  
According to the ANAO, the audit will not comment on the ‘merits of government policy’, but rather focus on ‘assessing the efficient and effective implementation of government programs’, including whether they achieve their intended benefits.
REC–FHSR member Dr Edwin Kruys told newsGP that while some form of compliance control on the use of public funds is ‘entirely reasonable’, it is ‘all about finding the right balance’. 
‘For example, the data-matching proposals in the recent Health Legislation Amendment Bill 2019 risk creating an Orwellian climate in Australian healthcare,’ he said.
‘“We don’t trust you” seems to be the underlying message, which can be deflating for health professionals.
‘It is not difficult to see how data-matching by the [DoH] can become a slippery slope and go beyond Medicare compliance in the near future.
‘There needs to be clarity and transparency about when and how the data will and will not be used by the department or any other parties.’
Dr Kruys added that the process of non-compliance management should be ‘fair and unbiased’, and the costs of compliance management in proportion to the expected benefits and cost-savings. 
‘The other big issue is that when the road rules are unclear, increasing highway surveillance doesn’t make much sense,’ he said.
‘We need more clarity of the rules around compliance, including, for example, Medicare item descriptors, as well as improved education and warning systems for health professionals.’
Audit submissions close 15 December.

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ANAO Australian National Audit Office compliance Department of Health MBS Medicare Medicare benefits Schedule

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SD   5/11/2019 10:29:17 AM

My feedback is:
1. A medicare item can be called a fraud just on the basis that someone did not like the GP notes. Medical notes are always done in a very short period of time and most of the time is spent on listening to patient needs and managing. Patient care is compromised if too much time is spent on notes.
Documentation error is not a fraud. It is extremely frustrating to come to work knowing that someone will ask you to pay back all the money you have earned for years.

2. Prescription errors should not be called a fraud. GP should be given education about avoiding this in future.

3. Actual GP consults which has been incorrectly billed should be asked to pay back and not the multiplication of the same item for number for years which can lead to fines in hundreds of thousands. This can easily destroy life, confidence and a career.
4. Out of fear of huge paybacks, GP will start under billing Medicare and become private to become cost effective.

Dr Obafemi Adeyemi Idowu   6/11/2019 3:29:36 PM

Billing for After Hours Items are not explicitly worded and very confusing. Tradesmen earn more than GPs afterhours. The so-called peer review comparison is quite inaccurate as apples are NOT being compared with apples. The watch-dog concerns include: Excision of multiple skin lesions from different parts of the same body at one occasion even though, fractional billing applies after the first excision; Billing appropriately with documentation for long consultations, despite lack of evidence of high/rapid patient turnover. In the mean time, the Govt runs around and talks about wanting GPs to spend quality consultation time with every patient, let alone griefing families or depressed suicidal individuals ;Ordering pathology tests to monitor treatment progress (Who protects GPs against AHPRA/Litigation Lawyers when things go wrong due to inadequate monitoring?).