Report finds referrals to professional services review for allegations of misuse of public money jumped from 44 in last financial year, to 62 this year
In cases referred to the PSR, which oversees Medicare, two practitioners were disqualified for six months and a further 11 were partially disqualified. Photograph: Joel Carrett/AAP
Health practitioners have been ordered to pay back $4.18m of taxpayers’ money as the number of referrals for allegations of misuse of public money has jumped 40%, a new report said.
The professional services review (PSR) is an independent body that investigates how medical professionals comply with the rules of Medicare. It tabled its 2014-15 annual report to parliament on Monday.
The number of cases referred to the PSR by the Department of Human Services, which oversees Medicare, jumped from 44 in the last financial year, to 62 in this one.
Two practitioners were disqualified for six months each as a result of the investigations, and a further 11 were partially disqualified.
A total of $4.18m in suspected misuse of Medicare claims has been recouped.
The independent body looked specifically at Medicare claims made by practitioners specialising in diagnosing and treating skin cancers, pointing to a number of examples in which practitioners averaged multiple services per patient, at a cost of hundreds of thousands of dollars.
“PSR committees find that there are many ‘grey areas’ in assessing whether practice has been inappropriate,” the annual report found.
The report also makes note of another grey area, that of services provided for chronic disease management. Chronic disease management services featured in a large number of compliance referrals in the 2014-15 financial year.
“Many practitioners who provide high numbers of these services use computer-generated templates; a plan may have minimal content specific to the patient for whom the plan has been prepared,” the report warned.
The federal health minister, Sussan Ley, expressed concern over the potential misuse of the chronic disease management schemes.
“We’ve seen over 22 million chronic disease management items alone claimed against Medicare at a cost of $2.7bn in the nine years since they were introduced,” Ley said in a statement. “This is significant when you consider the number of Medicare items claimed have now reached an average of one million per day.”
“It shows our current system that bills Medicare every time a single service is delivered isn’t providing the best outcomes for patients, health professionals or taxpayers managing chronic disease,” she said.
The head of the Australian Medical Association (AMA), Brian Owler, acknowledged that there was a problem, but criticised Ley for politicising the issue.
“We at the AMA have said to ministers for some time now that the chronic disease management items and the GP management plans need to be reviewed,” he told ABC Radio. “We know that the rules around them are somewhat difficult, and we know that there have been cases of misuse.”
“There is no reason for the minister for health to come out trying to flex her muscles and suggest that the profession is rorting the system, and that she’s taking action,” Owler said.
He argued that the vast majority of doctors do the right thing.
“We’ve got 100,000 doctors registered in this country,” Owler said. “And so, when you look at those figures, it is a very, very small number of people that are doing the wrong thing.”
“I think it’s about time that this government actually started to appreciate their general practitioners and stop painting the profession as people doing the wrong thing so that they can just find more savings in the budget,” he said.
A review of all of the nearly 5,800 items on the Medicare benefits schedule began in September.
Ley said the review was needed to weed out unnecessary, unsafe and out of date procedures currently on the schedule.