Medical imaging companies have been accused of exploiting a Medicare loophole to charge patients and the government more for services.
The ABC has learned some companies are making vulnerable patients who need multiple scans return over a number of days.
The practice helps them avoid a Medicare billing regime where set fees are reduced for second and subsequent scans conducted on the same day.
Making patients return can save imaging practices as little as $5 or as much as half the standard cost of a scan.
It comes after the ABC revealed earlier in the year specialist doctors could be raking in millions of dollars by forcing patients back to their GP for a fresh referral each year.
But the imaging industry said sometimes there were legitimate medical or logistical reasons to ask patients to return on different days.
Charging at the higher rate also gave them more capacity to bulk-bill patients.
However, in cases where practices do not bulk-bill, it results in the maximum gap payment for patients.
Consumer advocates said asking patients to make unnecessary repeated visits was a waste of time and money.
“If it’s not medically relevant … then this could be a significant cost burden on the Australian health system and one that requires review,” Consumer Health Forum chief executive Adam Stankevicius said.
Government spending on imaging has risen more than 40 per cent in the past five years and makes up about 10 per cent of the Medicare budget.
The patient gap charges, the difference between the cost and the Medicare rebate, are also up with the average imaging gap now $88.
Elderly mother told to return three times
When Margaret Walsh’s 91-year-old mother, Helene, was suffering heart problems in the months before she died, she was sent for scans at Perth Radiological Clinic at Bethesda Hospital.
“She was told by the clinic they could not do all three scans in one day … [that] they could only do one a day, and that was a rule by Medicare,” Ms Walsh said.
Helene Groves was independent for her age and did not tell her children about needing the scans.
“So she took herself off on three days in the middle of summer. She couldn’t cope and got breathless,” Ms Walsh said.
“She ended up having to call an ambulance.”
Ms Walsh wants people to know they might not have to make multiple trips.
She said her children have had similar experiences when they needed scans.
“It’s costing us more for that gap payment – it’s costing the Government a lot more, and that’s every one of us as taxpayers,” Ms Walsh said.
“It’s the inconvenience of the patient having to come back and the stress.
“I think it’s terrible … it’s almost fraud on behalf of the X-ray practices doing this.”
Geraldine Ormonde from Perth Radiological Clinic said Ms Groves’ case was not straightforward.
She said Ms Groves had a CT scan one week and, based on problems with its findings, her GP requested two ultrasounds a week later.
One required fasting and the other a full bladder.
“These two investigations are therefore usually separated in time to maximise patient compliance with the preparation required and for patient comfort,” Ms Ormonde said.
Ms Ormonde said they had a policy of bulk-billing pensioners like Ms Groves.
The practice claims that, for certain tests, Medicare will not insure the patient for two tests on the same day, resulting in the patient having to pay for the second scan.
“Some of our patients therefore elect to have the examinations 24-hours apart, so they may receive their Medicare benefit,” Ms Ormonde said.
“As a general principle, Perth Radiological Clinic makes efforts to minimise the out-of-pocket charges to patients where they can, within the scope of the Medicare rules.”
Common practice for patients to return
The imaging industry said it is common for patients to have to return for multiple scans.
Australian Diagnostic Imaging Association chief executive Pattie Beerens said sometimes there were medical reasons for needing to return.
This included patients who had contrasts or isotopes in nuclear medicine, which could interfere with CT scans.
Various injections could not be done at the same time because they were painful or could interfere between medications.
Ms Beerens said the industry had long been under pressure since rebates were frozen without indexation in 1998.
“Under current Medicare regulations the rebates paid to patients are reduced by up to half for the second (and subsequent) imaging services performed in the one visit,” Ms Beerens said.
“This reduced rebate in no way reflects the practice’s actual costs of delivering the service which effectively remain steady.”
Patients billed for cancelled appointments
Medical advocate Lorraine Long says the imaging industry has many poor practices.
The Medical Error Action Group founder has personally been bulk-billed twice for appointments she made but later cancelled.
“There’s obviously a pattern that when you make an appointment they obtain your Medicare number, then they bill Medicare whether you turn up or not,” Ms Long said.
She said she frequently saw evidence of “double-dipping” by medical practices.
In some cases, patients were bulk-billed for clinicians they never saw or billed for visits they never attended.
“I think it’s conniving more than rorting. Because I’m seeing it right across the board,” Ms Long said.
“I’m not just seeing it in Sydney, I’m seeing it across Australia, and I see a lot of Medicare reports that have that view.”
Australian Diagnostic Imaging Association chief executive Pattie Beerens said they had not heard of cases of billing for cancelled appointments.
“We would encourage anyone who thinks the system is being rorted to talk to Medicare,” she said.
Patients encouraged to report fraud
A Department of Human Services spokeswoman said the department had compliance activities to address inappropriate practice and fraudulent activity.
“Any changes to Medicare would need to be considered by the Department of Health,” she said.
“The Department of Human Services administers Medicare programs in line with the current policy and legislation.”
Do you know more? Email: investigations@abc.net.au