Medicare complexity the real scandal: RACGP CEO

Paul Wappett

18/10/2022 5:24:02 PM

Sensationalist reporting does the extraordinary, often unsung, work GPs do for their patients an enormous disservice, writes Paul Wappett.

Medicare card with money.
Even the highest previous estimates of non-compliant Medicare claiming fall well short of the supposed leakage now being reported as fact.

As the CEO of the RACGP, I have never worked on behalf of a group of people so committed to their communities and the public good.
Every day in my job, I encounter the extraordinary altruism of our GPs – none of whom go into the job to get rich.
These people offer pro-bono care to Ukrainian refugees not eligible for Medicare. They recruit their family members to staff weekend vaccination clinics just so patients can feel more comfortable when getting immunised. Some have even been known to accompany a patient when they put their dog down, simply for emotional support.  
That is why the sensationalist ‘greedy doctor’ narrative that has dominated the media this week has been so distressing.
It is also misleading and wrong.
Let me clear: anyone who deliberately sets out to rort public money, particularly when it has been set aside for the benefit of sick and vulnerable people, deserves to be prosecuted.
But the rort claim that dominated the narrative is not even shared by the main source for the program, Dr Margaret Faux.
Her own PhD, published in March this year, says the theory that Medicare leakage is ‘principally attributable to misconduct and fraud can no longer be upheld’.

RACGP CEO Paul Wappett says the ‘greedy doctor’ narrative dominating the media this week has been distressing.
Despite recent claims of widespread misuse by doctors and other healthcare providers, instances of proven Medicare fraud are miniscule.
For example, the most recent annual report out of the Professional Services Review – one of four compliance layers doctors accessing Medicare are regulated by – reveals there were fewer than 100 instances of proven inappropriate practice in 2020–21.
The sum total of this ill-gotten money, all of which was recovered, was $24,674,440. To be sure, these cases do not capture every instance of Medicare misuse in Australia, but it is a far cry from the apparent $8 billion being leaked from the system each year.
Even the highest previous estimates of non-compliant Medicare claiming fall well short of the supposed leakage now being reported as fact.  
It’s partly why these curiously timed articles, ostensibly supported by a PhD thesis published six months ago that actually estimated Medicare non-compliance was less than half what is now being claimed, feel like a knife through the heart.
It is no secret that GPs have been carrying a heavy load, particularly since the arrival of COVID-19.
From managing COVID-positive patients and offering life-saving vaccinations (despite not being considered ‘front line’), to helping with disasters and the mental health fallout from extended lockdowns, the profession has assumed a lot of additional responsibility.
Many are now struggling with the ongoing pressure this extended reliance has generated, and without adequate support from government are looking to transition into other areas or retire altogether.
Meanwhile, those outside looking in, especially medical students, are also witnessing the systematic erosion of general practice and voting with their feet.
For me, that is the real worry.
It’s why I’m far more concerned about a Medicare system that is overly complex and clearly not fit for purpose than the threat posed by a minority of bad actors in a sector overwhelmingly filled with good, honest people.
Especially as many of the examples contained in the articles are anecdotal or not evidence of fraud at all.

One only needs to read the most recent Health of the Nation report to recognise the overwhelming evidence that general practice’s current working conditions are not sustainable.
And unlike these recent fraud claims, the evidence is clear, quantifiable, and consistent.
For years, GPs have been warning about the problems with Medicare.
Its absurd complexity and vague item number descriptors. The incentivisation of procedures and short consultations over longer, holistic care. A punitive approach to audits that are driven by statistical models and developed by people who simply do not grasp the work GPs do.
When combined with rising patient violence and a ‘gotcha’ media culture that leaps on any suggestion that there are greedy doctors rorting the system, it is easy to see how some battle-weary GPs may be looking for the exit.
All of which should be terrifying for the general public and front-page news on every paper in the country, particularly with the new Federal Government’s crucial first Budget only days away.
Because without a strong, healthy, well-resourced general practice sector, our hospitals will be overrun, and Australia’s health and wellbeing outcomes will be severely compromised.
The overwhelming majority of GPs entered general practice to serve their communities, and these reports are an insult to their commitment to public good.
Do not blame them for systemic issues that they have been trying to warn us about for years.
Support them, in the same way that they support us – from the cradle to the grave.
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Dr Conor Calder-Potts   18/10/2022 7:33:02 PM

Good response Paul. It took a few deep breaths from me as well. It is classic spin doctoring that requires a measured and sensible response to the absurdities of politics. Please don't let the thousands of GPs be insulted by what the media is accusing against GPs.

A.Prof Christopher David Hogan   18/10/2022 9:57:13 PM

It seems a strange situation.
GPs & others have proved that it is not possible to subsist on universal Bulk Billing.
Many GPs have left the discipline & we have significantly fewer recruits to our training programs.
For those left in General Practice "government sources" accuse them of massive rorting
Does this mean that the government believes the only way to stay in practice is to rort the system?

Dr Don Yiap   19/10/2022 9:18:53 AM

The representatives of GPs - the AMA and RACGP should be addressing this outrageous attack and defend the GP's, most of whom are honest hard working and apolitical. I do not see any headlines reporting a response from the Doctor representatives to the fraudulent claim. I do not even see how the 8 billion number was calculated. Am I missing something here ??

Dr Jeevaka Samarasinghe   19/10/2022 12:23:08 PM

Good response Paul.
However the college needs to do everything possible to highlight our side of the argument to the public ; not just to colleagues who are all too familiar with the real issues with Medicare.
Kind Regards
Jeeve Samarasinghe
GP Central Coast

Dr Rathini Somasundaram   19/10/2022 12:52:29 PM

Let’s look at the beam in our own eye. We all know that there are a minority of fellows who overbill and deliver sub-standard medical care. Maintaining standards is a collegiate responsibility.

Dr Javier Armando Campuzano Ortiz   19/10/2022 1:03:55 PM

well for me is like this:
I started medical school a couple of months short of turning 17 years of age, I have worked for 22 years since graduation, being a doctor is the only job I have had and is the only thing I know how to do, I have done a masters and completed successfully the examination assessments of 2 Australian colleges and my consult is less than 40 dollars at the moment, where I can sometimes save someone's life and:
Medicare assumes I am a thief until proven otherwise.
Ahpra will assume that I'm am negligent and incompetent until proven otherwise.
patients think I don't want to help him because I don't necessary agree with some of their agendas and think I collude with the governments or some other sort of conspiracy attempting their freedoms ( they will gladly pay and listen to the homeopath) and all I have in front of me is 25 years more of it. At this point is more about "surviving" my career more than anything else. Good look to you all!

Dr Babak Afshar Ebrahimi   19/10/2022 1:33:55 PM

I felt so disappointed when I heard the news.
As a full time GP, I have a seen a few of my colleagues left the job due to "Burn Out" over the past year which is totally understandable considering most of us have not even had "a week" off work since early 2020.
Yet, I have not felt supported by my college or AMA in this regard.
We need action NOW , or we could end up with doctors being wrongly targeted and assaulted by angry "taxpayers".
Should we all leave the practice for the authorities to finally understand we are struggling?

Dr Andrew John Booker   20/10/2022 11:13:55 AM

When will the college start to show some REAL leadership and start a serious campaign to promote the true value of a GP. Not by wasting more time trying fruitlessly to convince government but start supporting members to feel worthy and capable of leaving rebate driven fees behind and charge an appropriate fee. NO OTHER specialties are restrained by the rebate! We are past a crisis point and while no-one would suggest it’s just a $ problem that GP training enrolments are at an all time low - it’s absurd to discount it.
PLEASE stand up for GP- whilst it’s noble to have patient care as an absolute priority - if there’s no GP left in the game - it will have been a waste of time.

Dr Tatiana Cimpoesu   24/10/2022 9:34:58 AM

Time for us ALL GPs, to stand up for ourselves, the new GP generation and in fact, for our patients.
If we stop working as GPs, maybe it will be noticed that general practice is the most cost effective part of the health system!