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GPs slam Medicare overbilling claims
The RACGP has fought back against a reignited ‘attack against GPs’, with the college president refuting union allegations of widespread and fraudulent overbilling.
The HSU’s report claims that Medicare ‘remains alarmingly unprotected’ and estimates fraud and non-compliance is costing taxpayers up to $10 billion a year.
As the Health Services Union (HSU) enters a fight for fairer wages for allied health workers in New South Wales, GPs have found themselves in the firing line as the union reignites controversial claims that doctors are overbilling Medicare and costing taxpayers billions of dollars.
In a report published by the HSU on Wednesday titled ‘Billions down the drain’, the union estimates fraud and non-compliance rates range from 5–30% and are costing between $1.5–$10 billion annually.
It claims that GPs made up almost 60% of Medicare Benefit Schedule repayments from Professional Services Review investigations in 2024.
The claims are a renewed blow, with GPs facing similar allegations from the HSU in 2023.
The RACGP has refuted the union’s $10 billion figure, pointing to an independent review in 2023 by Head of Deloitte Access Economics Australia, Dr Pradeep Philip.
College President Dr Michael Wright called for the HSU to retract its latest claim.
‘These allegations have already been proven false,’ he said.
‘A thorough independent review of the claims the HSU is now repeating found no evidence to support them.
‘It showed where there was incorrect billing, this was rarely fraud and mostly inadvertent errors, and that GPs too often underbill Medicare due to its complexity and fear of punishment.’
The independent review looked into claims about Medicare rorting made by the ABC’s 7.30 program and Nine Newspapers in a joint investigation in October 2022, which claimed $8 billion was being lost through fraud and non-compliance.
It found an estimated $1.5–$3 billion was ‘leaking’ from the system every year, predominantly due to honest billing errors resulting from the complexity of the Medicare system, rather than premeditated fraud.
Dr Philip’s report also found fear of the punitive compliance regime in place is actually leading to many GPs underbilling Medicare, rather than overbilling.
This was also backed by research undertaken by the University of Sydney, which found GPs undercharge at a rate of eight times they overcharge, with the authors concluding that the findings of the study ‘do not support the media claims of widespread fraud by GPs’.
Dr Wright said that the vast majority of GPs are trying to do the right thing.
‘Not only that, many GPs are underbilling out of fear of compliance, with our 2022 Health of the Nation report finding almost half of doctors either avoided providing some services or claiming patient rebates out of fear of Medicare compliance,’ he said.
‘GPs work under a tremendously complex Medicare system which features over 6000 individual items, on top of all of our other responsibilities, and we do our best every day for patients.’
The HSU’s controversial report is being used to support the union’s pay negotiations for 25,000 NSW allied health workers, after multiple enterprise agreements ended on Tuesday.
Off the back of the report, HSU National President Gerard Hayes has called on the Federal Government to overhaul the Department of Health, Disability and Ageing’s Medicare compliance approach by introducing mandatory real-time reporting for high-risk billing categories.
The union is also advocating for the establishment of an independent Medicare Integrity Commission, as well as implementation of AI-driven Medicare monitoring and real-time fraud and non-compliance detection.
‘While our members are struggling to make ends meet and considering leaving the profession due to poor pay, billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing,’ Mr Hayes said.
However, with greater demand being placed on general practice services, Dr Wright said the union’s claims are the last thing GPs and practice teams need at a time when they are needed by their communities more than ever before.
‘I know it’s not easy, but I urge GPs to ignore the latest reports, hold their heads high, and continue doing what they do best – providing high-quality care to patients across Australia,’ he said.
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