Almost 500 West Australian GPs are set to be contacted by the Department of Health and Aged Care for Medicare claims made for services provided while they are believed to have been overseas.
A spokesperson for the Department of Health and Aged Care told Medical Forum more than 5800 letters were being sent to health practitioners around the country in regard to “potential non-compliance”.
A total of 488 of those letters are destined for WA GPs.
“As part of compliance activities, the department has identified potential non-compliant claiming of Medicare Benefit Schedule (MBS) benefits by general practitioners while they were overseas,” the spokesperson said.
They said the potential breaches were identified via a data matching exercise.
The potential incidences of non-compliance related to the treating doctor being overseas at the time of the consult, not about patient whereabouts.
The GPs identified by the Department are expected to receive a letter encouraging them to “review their billing processes and take any necessary action, including returning any incorrectly received government benefits, and ensure future services are not billed to their provider number while they are overseas”.
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In addition to paying back compliance debt, GPs could also face penalties, which are generally charged at 20% of the recoverable debt amount.
Overseas billing was a focus at the recent six-monthly general practice compliance roundtable attended by the RACGP, along with other primary care and medical indemnity providers to discuss emerging compliance issues.
RACGP Vice President and WA Chair Dr Ramya Raman said the College would continue to work closely with the Department to ensure doctors were following correct billing requirements, however she is keen to see an education approach is taken.
“An education-first approach helps GPs make sure they’re compliant without causing a high level of stress that can compromise their own mental health and wellbeing,” she said.
“GPs have a lot on their plate, and there are so many rules and requirements we must follow every day.”
Dr Raman said there were steps GPs could take to help make sure they’re compliant.
“These include the option of closing your provider number before heading overseas and then re-opening on return to our shores, this prevents any unintentional use of that provider number for services which happen when they’re not in Australia,” she said.
“It’s also worth checking with your medical indemnity provider as they may have specific advice on claiming MBS services.”
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The Department of Health and Aged Care spokesperson said: “While telehealth provides more flexible access to care for many patients, it is a priority that high standards of care are maintained, and patient safety is supported.”
They pointed to the Health Insurance Act 1973 which requires services, including telehealth, to be rendered in Australia.
“This means the patient and the health practitioner are required to be in Australia at the time of the service,” the spokesperson said.
“Health professionals are responsible for ensuring services billed to Medicare meet all legislative requirements.
“This applies regardless of whether the services are: personally performed by the medical practitioner, performed by a non-medical practitioner that are supervised services, provided in-person or via telehealth, and practitioners retain contemporaneous records that support their Medicare claims.”
The Department spokesperson said data matching was “undertaken in addition to other intelligence signals and advanced analytics, supported by tip-offs”.
The mailout is expected to be sent in mid-May.
A fact sheet has also been developed and will be made available on the Department’s website for health professionals to access.
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