Investigations into health practitioners rorting the Medicare Benefits Schedule (MBS) rose by 40 per cent in the last financial year, a report has found, with doctors ordered to repay more than $4 million worth of benefits claimed.
The findings form part of the Federal Government’s independent Professional Services Review (PSR) Agency’s 2014-15 annual report, which will be released today.
The review panel is made up of doctors investigating the work of their peers.
Of the matters referred for investigation, 70 per cent resulted in further action being taken, including the repayment of Medicare benefits for wrongly prescribed chronic disease management plans.
Reprimands and restrictions on health practitioners being able to access Medicare benefits in the future have also been ordered.
Federal Health Minister Sussan Ley said the PSR report highlighted reasons why such rorting was occurring and that it was sometimes through inaction.
She said some health practitioners were failing to record their patients’ medical histories in the most detailed manner, and some were not following up with their charges after putting in place chronic disease management plans which may not have been required.
“We need clear, strong rules around the use of individual Medicare items to make sure they’re clinically relevant, they reflect contemporary practice and they’re not of course misused for financial gain — small though that misuse is,” Ms Ley said.
“The instances of non-compliance are very small.
“However, for patients who are not getting the benefit of the treatment they’re supposed to, the outcome for them is poor, and for the taxpayers footing the bill, the outcome is unacceptable.”
The release of the annual report comes as the Government pushes its plans for a wide-ranging review into 5,700 items on the MBS.
“It’s important that the MBS items are not so prescriptive that they become restrictive, but it’s also important that they do not allow areas that are ambiguous,” Ms Ley said.
“We know that our current system that bills Medicare every time a single service is delivered, actually isn’t providing the best outcome for patients.
“These chronic disease management items misuse features in about half of all of those compliance cases, and their report actually does specifically say that this is just too easy.”