Corporate toes boundaries with rewards program

4 minute read

A chain of GP clinics is under fire from consumer advocacy groups after withholding bulk billing from patients who didn’t sign up to its rewards program.

GPs aren’t allowed to charge any additional fees when they bulk bill, but a corporate clinic appears to have identified what patients and consumer advocates consider to be an unethical loophole.

On Tuesday, Consumer advocacy group CHOICE revealed that Cornerstone Health – which operates 13 clinics as Our Medical in Queensland, NSW and Victoria – now requires patients to join its rewards program and download its app as a prerequisite to being bulk billed.

Joining the program requires signing over certain pieces of personal information, which Cornerstone and its contractors or service providers are then able to use for “administrative, marketing, planning, product or service development, quality control and research purposes”.

The natural fear from patients who approached CHOICE was that their personal data would be sold on to third parties for Cornerstone’s commercial gain; one told the consumer advocacy group that she felt like she was being used as a “marketing tool”.

The same patient told CHOICE the alternative to signing up was a $90 out-of-pocket fee.

Data ethics researcher Professor Jeannie Paterson called the practice “ethically outrageous”.

Cornerstone told The Medical Republic that Our Medical “has not and will not ever use personal data for commercial purposes or share it with third parties for financial gain”.

The reason it put in the requirement to join its rewards program in exchange for bulk billing, it said, was to ensure that patients had up-to-date information in its system.

It said the information captured in its rewards program was nothing that wasn’t already captured via the regular patient registration process.

Section 20A of the Health Insurance Act 1973 states that, when bulk billing, a doctor is accepting the Medicare reimbursement as their entire fee.

For example, the subscription model – where patients pay a one-off “membership fee” in exchange for being bulk billed – is considered to likely be illegal in most cases, even though it has not been tested in court.

It’s unclear whether Cornerstone, should it ever choose to monetise the patient data it collects via bulk billing, would be in contravention of the Act.

“Certainly, I don’t think the Act was written with the idea that people might be incentivised in other ways to do certain things in order to get bulk billed,” CHOICE consumer advocate Kate Bower said.

“They’re not technically asking for payments to be bulk billed, but they’re still getting something from the transaction.”

Ms Bower said CHOICE’s main concern was that patients of the Our Medical clinics had been put into a position where they were effectively choosing between accessible medical care and their privacy.

“We think in the context of people being unwell when they’re booking a doctor’s appointment, it’s really too much of a burden to push [them to sign up to an app] or … to be out of pocket when they would normally be bulk billed,” she said.

“I think it’s particularly egregious that this business heavily advertises itself as a bulk billing clinic, but then the only way to get a bulk billed appointment is to sign up to their rewards app.”

She also questioned the need for a medical centre to have a rewards program in the first place, given that it could be seen as encouraging people to make appointments when they are not necessarily ill.

“The rewards that they’re offering, like $20 off a [co-located] physio appointment or something like that, are all well and good if you need physio, but if they’re actually incentivising people to get physio that they don’t need – that’s where you see this is not really the best idea,” Ms Bower said.

The Department of Health did not respond to a request for comment before deadline.

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