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Softer tone in new compliance letter after RACGP questions
Hundreds of GPs will receive a warning letter this week around mental health treatment items, triggering RACGP concerns over targeting.
A new warning letter is targeting GPs’ billing of mental health care plans.
The new compliance letter will be sent to 341 GPs who are co-claiming professional attendance alongside mental health items around 90% of the time.
According to a sample Department of Health (DoH) letter, the average co-claiming rate is 23%.
The sample letter seen by newsGP indicates the letter will cover GPs claiming professional attendance items and GP mental health treatment items ) for the same patient on the same day.
The language in the new letter has noticeably softened after the RACGP questioned the tone of previous letters, with no mention of GPs being referred to the Professional Services Review for investigation.
Instead, the letter requests that GPs review the claims in question, pay back any erroneous claims and states that compliance action such as an audit may take place if claims do not meet MBS requirements.
But the RACGP has still questioned whether this letter is appropriately targeted, given GPs treat the whole person and that many patients do not present for a single issue.
The percentage of Australians seeing their GP for mental health concerns has more than doubled in a decade, rising from 4.3% of the population to 8.7% since 2008–09 according to new Australian Institute of Health and Welfare data.
Almost two thirds of GPs nominated mental health as the most common health issue their patients sought help for, according to the 2019 General Practice: Health of the Nation report.
In recent months, the RACGP has grown concerned that the Department of Health’s increasing focus on outliers is leading to GPs feeling unfairly targeted – especially when there are legitimate reasons for billing.
In a December submission to an Australian National Audit Office audit of the DoH’s approach to health provider compliance, the college called for improvements to the way non-compliant cases are identified and how issues are communicated.
‘Compliance measures are unnecessarily intimidating in some cases … [M]any of the Department’s targeted compliance warning letters state that the GPs identified may be referred to the Professional Services Review,’ the submission states.
‘Guidance on appropriate use of MBS items can be ambiguous and contradictory.
‘There is a growing perception that compliance activities are designed to monitor and target statistical outliers, as opposed to targeting fraudulent activity.’
Many GPs are now reluctant to use item numbers with higher rebates for longer consultations due to the fear of being identified as an outlier, the submission states.
The mental health letter is the latest in a string of ramped up compliance efforts by the DoH that rely on statistical detection of outliers in Medicare Benefit Scheme billing for specific items and billing ratios. The increase comes after the Government announced almost $10 million to increase MBS compliance in May 2018.
Previous letters have targeted psychotropic medication, bulk billing incentive items, acupuncture, and the 80/20 rule.
The largest compliance push in recent years was a 2018 letter sent to almost 5000 GPs warning about opioid prescribing rates. That letter triggered a strong pushback from GPs over the tone and fear that it engendered.
Australia’s Chief Medical Officer Dr Brendan Murphy – soon to be Health Department Secretary – responded to GP concerns in an open letter in newsGP and apologised for any anxiety and distress caused.
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