GP clinics could face fines for falsely claiming to be part of the bulk billing PIP under the proposed Health Insurance Amendment Act.
The RACGP “cannot endorse” plans to allow AI use in compliance checks unless amendments are made to the upcoming health insurance bill, its new submission says.
The Health Legislation Amendment (Incentive Payments and Other Measures) Bill 2026, aims to establish a framework and to modernise the health incentive payment programs.
While the college supported the bill’s goal of modernising Commonwealth incentive programs, it warned of insufficient safeguards against administrative “red tape”, the risk of “Robodebt-style” automated decisions, and a lack of “lock-in” measures to keep payments in step with inflation.
RACGP president Dr Michael Wright told The Medical Republic that, with the uptick in AI use to manage compliance activities, human oversight, transparent decision-making criteria and review mechanisms remain essential.
“There is a risk that inaccurate AI-driven decisions could disproportionately burden general practices, particularly where compliance is assessed without adequate consideration of… practice and patient demographics, leading to incorrect decisions and lengthy review or appeals processes,” the submission read.
“The practice incentive program plays a critical part in ensuring the financial viability of practices,” he said.
While health minister Mark Butler has promised a seamless transition to the new framework without reapplication, Dr Wright said further work would be needed to determine whether the legislation would truly be seamless or if it would impose an additional administrative burden.
Namely, the RACGP called for the bill be amended to stipulate that “measures for incentive payments will, at a minimum, keep pace with inflation”.
“The profitability of practices is marginal, so any extra administration required to comply with in order to access incentive payments must be resisted so practices can focus on providing the care our patients need,” Dr Wright said.
“We can’t afford to lose any practices. Our patients deserve better than that,” he told TMR.
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Another concern was the lack of clear criteria or principles to guide the secretary’s or chief executive’s discretionary approval or rejection of incentive payments, risking transparency, accountability, and consistency.
Once legislation is implemented, the RACGP recommended forming an expert advisory group with key stakeholders.
While the RACGP supported preventing wrongful claims, it urged proportional fairness by distinguishing deliberate misconduct from administrative errors and suggested prioritising education and opportunities for professionals to rectify billing practices before compliance actions.
“We’ve asked [Health, Disability, and Ageing] Minister Butler to report back to parliament on the proposed actions within six to 12 months of the legislation’s commencement,” Dr Wright said.
At a senate committee hearing on the proposed legislation held in Canberra on Wednesday, the division manager of DoHDA’s Medicare benefits and digital health division Duncan McIntyre said the secretary or chief executive of Medicare would be able to “arrange for computer programs to take specific incentive payment program administrative action”.
Bethan Lewis, assistant director in the Medicare benefits and digital health division, said there would be two levels of internal review and the ability to appeal to the Administrative Reviews Tribunal.
“In addition to … requesting a review if somebody’s unhappy with their decision, there’s also quality assurance processes to check automated decisions and substitute them by a human decision-maker if they are considered to be the incorrect or the not preferable one,” Ms Lewis said.
Ms Lewis also confirmed that there would be larger civil penalties relating to clinics which make “false representations” about participating in an incentive program.
“For example, with the new bulk-billing practice incentive payment program, signage is one of the requirements to advertise to patients that this is a centre where you will not be required to pay anything,” she said.
“Now, unfortunately, there’s already … been the circumstances of practices using signage essentially as a lure, but then charging patients.
“Or conversely, that they are in the program, but they’re still … charging people, and they shouldn’t be.
“So, any kind of false representation … these kinds of representations are really important to patient choice. They need to understand where clinics are they can go and what they should be charged.
“There’s physical signage, and there’s also digital signage on Healthdirect that’s required as well.
“If that is misleading, then we think that it’s appropriate to have a penalty attached to that because these are really … important issues affecting patient choice.”
The final report from the senate committee is due on 14 August.
