Multi-million payback after Medicare misuse
Doctors have been ordered to repay more than $4 million worth of benefits, following a report into rampant Medicare rorting.
Investigations into health practitioners abusing the Medicare Benefits Schedule (MBS) have been submitted ahead of the Federal Government's independent Professional Services Review (PSR) Agency's 2014-15 annual report.
The review panel features doctors tasked with investigating the work of their peers.
The pre-PSR report found that 70 per cent of the matters referred for investigation required further action, including paying back Medicare benefits for wrongly prescribed chronic disease management plans.
It has also led to reprimands and restrictions, that will limit health practitioners ability to access Medicare benefits
Federal Health Minister Sussan Ley says the PSR report shows some health practitioners are failing to record medical histories in enough detailed, while others were found not to have followed-up with patients after setting up chronic disease management plans.
“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 annual report could add inertia to the Federal Government’s push to tighten Medicare provisions, including a review of all 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.”