Proposed data-matching laws could lead to excessive monitoring of GPs: RACGP

Doug Hendrie

30/09/2019 3:57:08 PM

The sweeping new laws would, if passed, allow the Federal Government to match datasets from the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme.

Monitoring data
New data-matching laws could significantly increase Medicare compliance efforts and lead to more monitoring.

The laws, which are currently out for stakeholder consultation, would also allow the Government to compare these with other major datasets, representing a major increase in potential compliance activity.
RACGP President Dr Harry Nespolon warned that this type of escalation in compliance activities must be done carefully.
‘We support the maintenance of the integrity of Medicare, but there are always concerns that data matching may be used for reasons other than ensuring the integrity of the system,’ he told newsGP.
‘We would also caution that if the matching process becomes too complex, it may produce inaccurate results or results that are misinterpreted.’
Dr Nespolon has previously raised concerns over the impact of current compliance measures on the mental wellbeing of GPs.
The laws are intended to reduce Medicare fraud, which the Department of Health (DoH) consultation paper estimates could cost the nation around $180 million a year if even 0.5% of Medicare payments are fraudulent or incorrect.
At present, the DoH – which is responsible for Medicare compliance – uses ‘a combination of tip-offs and data analysis of existing Medicare datasets’ to detect fraud and incorrect claiming, according to the consultation paper.
‘While tip-offs will continue to be a highly valuable source of information, the [DoH] is limited in its ability to analyse Medicare data to identify non-compliance,’ the paper states.
The paper also stresses that ‘the vast majority of Medicare providers do the right thing’.
The new datasets would include the Therapeutic Goods Administration (TGA), with data mined to find health providers claiming Medicare Benefits Schedule (MBS) benefits for ineligible medical devices, as well as registration data kept by the Australian Health Practitioner Regulation Agency (AHPRA) to identify doctors practising outside of registration conditions.
Other datasets could include Department of Veterans’ Affairs, which would be used to identify double-billing, Department of Home Affairs immigration data, used to find Medicare claims made when the doctor or patient was not in Australia, and private health insurance data to find MBS claims made incorrectly within private hospitals.
My Health Record data would not be subject to the new laws.
In contrast to the controversial robodebt data-matching program – which is now the subject of a class action lawsuit – the Government does not plan to undertake compliance activities without human oversight.
Automation of debts or compliance activity is deemed ‘out of scope’ in the consultation.  
The proposed data-matching bill could potentially clash with proposed new data-sharing and release legislation, designed to promote better sharing of public sector data with appropriate safeguards in place. 
GPs can comment directly to the DoH during the consultation process until 11 October, or provide feedback to the RACGP to inform the college’s submission.

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Dr Glenn Calvin Davis   6/10/2019 3:23:38 PM

Medicine took an earlier flight (Henry Greenberg)…"a new threat has emerged....HMOs have arrived in Gotham....with little extra effort they reduce the physician to an employee …..and the doctor will measure his life in degrees of compliance with cost-driven algorithms and will hone his skills to reduce an office visit to seven minutes"