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Medicare watchdog repayments soar by $10m
The PSR recouped $32 million from negotiated agreements and determinations last year, often through doctors’ ‘lack of clinical input and poor record keeping’.
There were 109 new cases received during 2023–24, the highest since 126 were reported in 2019–20.
Medical professionals were made to pay $31.6 million by the Medicare watchdog, the Professional Services Review (PSR), in 2023–24, a $10 million rise from the year before.
That is according to the PSR’s Annual report, which this month revealed the total it received through negotiated agreements and final determinations.
The $31.6 million figure is compared to $21.6 million the year before, $19.0 million in 2021–22, and $24.7 million in 2020–21.
‘Concerns identified often related to a lack of clinical input and poor record keeping,’ the report said.
‘When practitioners are very busy, clinical notes in records can become poor which is a risk to patient safety.
‘As always, there is a need for practitioners to balance their workload to ensure there is sufficient time to make accurate clinical notes in patient records to safely ensure continuity of care.’
RACGP President Dr Nicole Higgins told newsGP this is easier said than done, with GPs still weighed down by administration.
‘Reducing red tape to GPs will give them more time to be able to document what matters in a consultation – documentation for documentation’s sake is not what we’re trained to do,’ she said.
‘We’re trained to diagnose and manage people, not to tick boxes to keep the bean counters happy.
‘But at the same time, we need to find that balance between the rules and safe, quality practice.’
The report revealed 109 new cases were received during 2023–24, the highest since 126 were reported in 2019–20.
No further action was taken in nine cases, and there were 14 reports finding inappropriate practice, with the largest repayment being $1.2 million.
Under the controversial section 92 of the Health Insurance Act, the PSR and a person under review can negotiate an agreement that ‘must include an acknowledgement by the person that they have engaged in inappropriate practice’.
In 2023–24, section 92 agreements saw 87 negotiated agreements come into effect, resulting in repayment orders totalling $25.8 million.
The PSR saw partial Medical Benefits Schedule (MBS) disqualification in 54 cases, full disqualification in one case, reprimand in 50 cases, and counselling in 44 cases.
The common items reviewed were level B, C and D consultations in rooms (MBS items 23, 36 and 44), chronic disease management items (MBS items 721, 723 and 732).
Also included were mental health items (including 2713 and 2715), and their equivalent telephone consultation items.
Dr Higgins said the college has worked very closely with the PSR to create an ‘educative versus punitive’ approach.
‘It’s about educating our members on the types of activities that might bring them to the attention of Medicare compliance and then the PSR,’ she said.
‘This is about making sure that people know what we do – we know what happens in our consult room, but we also need to demonstrate that.’
Earlier this year, PSR Director Associate Professor Antonio Di Dio told newsGP he does not want the review to be seen as a ‘scary, hidden monster’, rather an organisation which is about fairness.
‘We exist in order to do two things: to protect the general public from the potential harms of inappropriate practice, and to protect the Commonwealth from paying for inappropriate healthcare,’ he said.
‘However, the way that we go about doing that, I’m really passionate about making sure that we do it in a way that is as safe and respectful as possible, and as transparent as possible.’
But Dr Higgins said moving forward, she has concerns for new doctors coming into the country through the new expedited pathway who may be unfamiliar with Australian medical compliance.
‘One of the roles of the medical colleges is to actually be able to provide education to these doctors, and my concern is that they will be at increased risk because they’re coming into a new system,’ she said.
‘Australia is very different to other countries around the world, with different regulation and legislation, and Australian-trained doctors struggle with this despite growing up in the system.
‘But coming in from another country takes it to the next level, so I want to make sure that these doctors are not put at risk.’
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