The Royal Australian College of General Practitioners (RACGP) says claims in the media of widespread Medicare rorting are sensationalist and not based in evidence.
A joint investigation by The Sydney Morning Herald, The Age and ABC’s 7.30 program published this week included claims that up to $8 billion a year is being lost from Medicare due to fraud.
RACGP President Adj. Professor Karen Price said the vast majority of GPs are doing the right thing. “It is extremely disappointing that such sensationalist accusations have been levelled at the medical profession, including general practitioners – the vast majority of GPs are doing the right thing and deserve the community’s respect,” she said.
“The assertions made in the media are based on limited data and loud opinions.”
– RACGP President Adj. Professor Karen Price
Adj Prof Price said the real problem with the Medicare item number system is that it is far too complex: “There are over 5,700 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.”
“Margaret Faux’s research on Medicare has been cited in recent media reports. However, most stories have incorrectly implied non-compliance is due to deliberate abuse, when in fact Faux’s research found the principal cause is the complexity of the system and margin for mistakes.
“Let me be clear – any misuse of public funds is abhorrent, and anyone who rorts the system should be prosecuted, and I would welcome the government’s investigation into this matter,” she said.
“However, until we see actual evidence of ‘widespread rorting’, we are just dealing with baseless claims and the opinions of a loud few.”
Compliance key concern for GPs
The RACGP President said Medicare compliance is a key concern for GPs. “The Department of Health has a long history of strong Medicare compliance processes and systems, and the fear of being accused of doing the wrong thing is very real for practitioners,” she said.
“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.
“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.
“The excessive complexity of the system and fear of being accused of doing the wrong thing is causing unnecessary stress and anxiety for GPs when they are just trying to do their best to care for their patients and communities.
“It’s a disincentive for doctors to join the speciality, and for those practising to keep doing so. GPs have told us that the administrative, regulatory and compliance burden that GPs face is taking time away from delivering actual care to patients and impacting the sustainability of medical services.
50% of GPs say ‘unsustainable’ to continue working as a GP
“The RACGP has been very vocal about the urgent need to secure the future of general practice patient services, amidst mounting evidence that general practice is on the brink,” said the President. “Over 3,200 GPs were surveyed for the 2022 Health of the Nation report, and almost half said it is financially unsustainable for them to continue working as a GP.
“These survey results are deeply alarming and indicate a very bleak future for general practice patients if nothing is done to address the situation.
“And it makes it especially hard to stomach the media allegations of widespread rorting of the system by greedy doctors. Who exactly is this narrative serving? The damage these allegations could cause in terms of affecting vulnerable and marginalised patients trust in their health services is immeasurable and shameful.
“When it comes to Medicare compliance, the RACGP has always said that education for doctors is key, rather than punitive measures which can distract providers from delivering appropriate and high-quality care to patients.
“Resources, support and easy to understand advice is urgently needed. And we will continue to urge the Department of Health to create an environment in which meeting compliance obligations and accessing useful educational resources is easy and stress-free. Because doctors should not be hobbled by excessive administrative and compliance processes when they are trying to do their best to care for patient across the country.”
AMA ‘extraordinarily disappointed’
The Australian Medical Association (AMA) says these claims are an unjustified slur on the medical profession, with the vast majority of doctors doing the right thing by their patients and by Medicare rules. The AMA believes the Department of Health should be guided by the extensive data at its disposal on Medicare compliance activities as opposed to the anecdotal evidence of a small number of individuals.
AMA President Professor Steve Robson said:
“Australia’s doctors have worked incredibly hard through COVID – treating Australians during lockdown, rolling out the nation’s vaccine efforts, putting themselves at risk every day to treat COVID patients on the front line – so today’s coverage is as appalling as it is inaccurate.
“Doctors will be sickened by today’s reporting which is an undeserved attack on the whole profession based very much on anecdotes and individual cases.
“The vast majority of doctors do the right thing, and are working hard for their patients under tremendous pressure within the system.
“The AMA works closely with the Department of Health on compliance and we have never seen any concerns or numbers that would support the figures reported today.
“We do not tolerate fraud and examples of fraud should be tackled and stamped out – but the figures reported today are grossly inflated.”
