Medicare’s compliance arm was allotted $146.8 million in this year’s budget. Here’s how it plans to spend that money.
Medicare plans to save $674.1 million over the next four years by reducing fraudulent and non-compliance claiming, and one initiative will be supporting providers to access new reports showing all MBS claims made under their provider number.
As part of the May budget, $146.8 million over four years was earmarked to go toward strengthening Medicare integrity.
The work was expected to build on that of the Philip Review into fraud and non-compliance, which itself was spurred by media claims of widespread Medicare rorts.
The key issues which affected the system, according to a Department of Health, Disability and Ageing-issues fact sheet, were incorrect claims, limited provider visibility of claims, fraud, and a reactive system which focussed more on identifying issues after they had occurred rather than preventing them.
That same fact sheet outlined five initiatives for the $146.8 million in funding to be split between.
These were: legislation amendments to “support fair, effective compliance” across the MBS and PBS, a “stronger” Medicare claiming system which identified “suspicious” claims earlier, more capability for the department to monitor for incorrect and fraudulent claims, clearer guidance and support for providers, and new reports showing all MBS claims made under a provider number.
“These changes will support you to claim correctly and confidently, through improved Medicare education that supports you in understanding and navigating Medicare claiming,” the fact sheet said.
“New practitioner claiming reports will provide greater visibility of claims made under individual provider numbers.
“This will help to identify and correct unintentional errors early, as well as detect any fraudulent or non-compliant claims made without your knowledge.”
David Dahm, an accountant with a special interest in primary care businesses, told The Medical Republic that GPs often ended up exposed to risk of fraud because they didn’t have optical visibility on how they were paid.
“You don’t have that near-real-time access [to what is billed under your name], is the best way to put it,” Mr Dahm said.
“And if it can’t be measured, it can’t be managed. … We do all tend to be quite busy, and we tend to assume away our problems based on trust, because we live in a trusting industry.
“[People say] ‘I trust my practice manager, I trust my accountant, and if there was a problem they would have told me’.”
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Mr Dahm said he was aware of several recent cases where practice staff had allegedly defrauded the clinics they worked at.
Part of the problem was that matching up billings and doing bank reconciliations was, well, boring.
“A lot of doctors say, ‘I don’t want to know [about the billing], you do the billing and receiving for me’, and that’s the first problem,” Mr Dahm said.
“They don’t want to know about it.
“Look, nobody likes billing. No professional person does. Doctors love the clinical interaction, the fun stuff. Admin’s boring, right?
“But that’s the first vulnerability. It’s a state of mind where I’ve just delegated to somebody else, and I trust them, and I trust their systems, but I’ve never really checked myself.”
The accountant encouraged doctors to take an interest in their billings, and to ensure that there was a separation of duties between the person who did the bookkeeping, the person who did the billing and the person who did the bank reconciliation.
