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GPs driven by ‘fear’ likely under-billed $350m in 2021–22
New analysis suggests GPs under-bill in more than 10% of consultations, while another report finds no evidence for $8 billion Medicare fraud figure.
The coverage on alleged Medicare fraud last year caused widespread distress and anger among GPs.
The level of Medicare under-billing for GP services is far higher than over-billing, newly published research suggests.
An article set to be published in AJGP this week includes analysis by University of Sydney academics of Medicare billing according to consultation length.
It indicates that more than one in 10 GP consults (11.8%) were under-billed from 2013–16, more than seven times the rate of overcharging, which researchers identified in 1.6% of all consultations.
Projecting the figures forward, they calculated that under-billing saved taxpayers the equivalent of $351.7 million of Medicare charges in the most recent financial year.
At the same time, The Australian also revealed top-level findings of a Federal Government-commissioned independent report into Medicare compliance which suggested no evidence to substantiate a widely-reported figure of $8 billion in fraud and non-compliant billing.
The research was carried out by health economist Dr Pradeep Philip in the wake of highly contested reporting by ABC’s 7.30 program and Nine Newspapers, much of it centred around general practice.
RACGP President Dr Nicole Higgins told newsGP both studies offer vindication to GPs, whom she says overwhelmingly do the right thing.
‘It comes as no surprise at all that an independent reviewer has also found the figure of $8 billion fraud and incorrect billing in Medicare as unfounded and baseless,’ she said.
‘Now, credible research has found GPs undercharge much, much more often than they overcharge – and that’s the real scandal that was completely missed in the reporting, along with the complexity, and increasing burden of Medicare compliance.
‘In contrast to the $8 billion figure, this research has been backed up by well sourced data that can be checked and scrutinised.’
The lead author of the University of Sydney study is Dr Christopher Harrison of the Menzies Centre for Health Policy and Economics, who said his research was prompted by the ABC and Nine Newspapers coverage.
‘There were quite a lot of reports last year around claims of widespread fraud in Medicare by doctors and GPs in particular, and from my 20 years of researching GPs, that didn’t sit right with me,’ he told newsGP.
The study used historical information from the Bettering the Evaluation And Care of Health (BEACH) program, a study of GP clinical activity from 1998–2016.
One sub-set of data included the start and finish time for consultations, allowing researchers to compare the item number charged.
Using information supplied by 2760 GPs for a total of 89,765 consultations, it found 84.6% GPs undercharged at least once, compared to 29.6% of those included in the study who overcharged – although this group was also highly likely to have under-billed at some point too.
The under-billing issue is particularly acute for claiming Level B items – consultations that in theory should last less than 20 minutes and are the most commonly billed item by Australian GPs – the academics wrote.
While Dr Harrison said he was previously aware of under-billing, he was surprised at the scale uncovered by the research.
‘I don’t think anyone realised how prevalent undercharging was by GPs,’ he said.
‘I knew it happened, which is a reason why I looked into it, but I wasn’t expecting 11.8% of standard consultations to be undercharged.
‘That was much larger than I was expecting.’
Altruism could play a part, he suggested, but he believes the compliance system is more likely to be the main driver.
‘I think the major reason, and this is backed up by surveys and other academic papers, is that GPs intentionally undercharge to avoid an audit and being flagged for review,’ he said.
‘If it is fear that is driving a lot of this undercharging, we need to address that because I don’t think that’s healthy.’
Dr Harrison said that while the most recent data available is from 2016, he believes the trends are relevant today.
The research also offers substantial backing to the findings of a newsGP poll last year, in which a huge majority of readers reported losing income due to Medicare under-billing.
The survey found almost all
newsGP readers (97%) reported missing out on a proportion of income due to under-claiming available patient rebates.
Almost half (49.7%) said they lose the equivalent of more than 20% of their total income through under-billing.
Many GPs also
highlighted the issue of under-billing when
newsGP requested feedback shortly after so-called ‘Medicare rorts’ coverage
first aired.
For Dr Higgins, the latest findings underline the need for urgent Medicare reform.
‘My message to my GPs is we cannot and will not carry on subsidising Medicare any longer,’ the RACGP President said.
‘I love being a GP, but we need the Government to step up and support us to help our patients.
‘When clinics around the country are being forced to close their doors, we have to say “enough is enough” and do what we can to survive.’
Dr Harrison also believes the scale of missed funding is not fully captured in the analysis.
‘We know that the non-billable time that GPs do is larger than the savings from undercharging,’ he said.
‘If you combine them together, you're probably getting close to a billion dollars that GPs are missing out on in either non-billable time or by undercharging.’
Dr Philip’s report is due to be made public later this week. The RACGP included a submission for his consideration, in which the college noted its disappointment that under-billing
was not included in the review terms.
Meanwhile, a number of high-profile GPs, including the RACGP President, her predecessor Adjunct Professor Karen Price, and Rose-Hunt Award recipient Dr Cameron Loy, have called for the reporting by the Nine Newspapers and ABC 7.30 to be subject to a Media Watch report.
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