MBS complexity is real culprit, says RACGP

4 minute read

‘Strengthening’ Medicare isn’t only about cracking down on abuse – the universal healthcare system’s true weakness lies elsewhere, says the college.

Proper education will go further than punitive measures in improving the Medicare system, the RACGP president said this afternoon, in the wake of media reports focusing on non-compliance.

“The real problem with the Medicare item number system is that it is far too complex,” Adjunct Professor Karen Price said in a statement.

“There are over 5700 different item numbers, many with vastly different rules and requirements, and this gives rise to innocent mistakes. Even the guidance on correct use of MBS items can be ambiguous at best, and contradictory at worst.”

The comments follow assertions in yesterday’s joint investigation by Nine newspapers and ABC’s 7.30 program that health professionals’ mistakes, over-servicing and even fraud were rorting the Medicare system.

Professor Price added that while she fully backed measures to counter and prosecute fraud, the current Medicare compliance system could potentially compromise patient care. 

“Our 2022 Health of the Nation report found GPs are changing their billing behaviour due to fear of compliance activities and confusion around claiming rules,” she said.

“Nearly half of all GPs surveyed, 47%, indicated that they either avoided providing certain services or avoided claiming patient rebates, despite providing services out of fear of Medicare compliance ramifications. And 61% reported that the complexity of Medicare is something that worries them outside of their work day. 

“Many practitioners feel they have been unfairly targeted by Medicare compliance activities, when in fact they have legitimate reasons for billing or prescribing a certain way. For example, many GPs order more pathology tests than their peers because this is what their particular patients need, not because they are ‘rorting’ the system.”

Following yesterday’s news stories, Health Minister Mark Butler asked the health department to review the current audit, compliance and Professional Services Review programs, along with an analysis of the work of Dr Margaret Faux, which underpinned much of the reporting.

“I’m not going to pre-empt what comes back to me and my own assessment of that,” Mr Butler told Patricia Karvelas on RN Breakfast this morning. “I mean, if there’s any change to the Professional Services Review system that I think is warranted, we’ll pursue that.”

The minister said suspected cases of fraud were always “pursued appropriately”, adding that the compliance program was “strong” and included advanced data analytics, among other tools, to try to identify cases.

“I’m always open to ways in which we can ensure that taxpayers get the best value for money, but also that claimers, health professionals and doctors are treated fairly, given proper natural justice and the like as well.”

According to Professor Price, education rather than punitive measures was essential for doctors since such measures can distract healthcare providers from delivering appropriate and high-quality care.

“Resources, support and easy to understand advice is urgently needed,” she said, “and we will continue to urge the health department to create an environment in which meeting compliance obligations and accessing useful educational resources is easy and stress-free. Doctors should not be hobbled by excessive administrative and compliance processes.

AMA president Professor Steve Robson told ABC’s RN Drive last night that he commonly went to meetings with Medicare where they looked at billing data “with a fine-toothed comb”.

“If we think something is being rorted, we say let’s make sure you investigate the people who are doing this, because it goes against the reputation of the profession,” Professor Robson said. “The best information we have is about one in a thousand have practices that are of concern and go to further investigation, as they should.

“The overwhelming focus of the profession is just providing great care.”

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