Sunday Telegraph 30 August 2009

What’s up doc? MDs’ charges to Medicare 


MORE than 1000 doctors claimed at least $l million in Medicare benefits last year. The biggest payout— $1,386,749 —went to a GP who claimed more than 26,000 Medicare payments for servicing 5200 patients.

Based on an avenge consultation of $33.55 that would mean the doctor seeing 158 patients every working day of the year.

But the doctor concerned - and those like him - are unlikely to face scrutiny for overcharging despite promises by the Rudd government to crack down on medical fraudsters.

That’s because under existing laws doctors who are audited through the Department of Health are not required to substantiate their Medicare claims.

Medicare Australia’s program review division general manager Cohn Bridge said this meant “noncompliant individuals could essentially choose not to be audited”.  Nor is there any financial penalty for doctors found to have received incorrect payments above a specified amount.

Previously unpublished figures provided to The Sunday Telegraph by
Medicare Australia show that under the existing laws there were only four successful prosecutions of doctors last year. This compared with 43 successful prosecutions of members of the public found guilty of Medicare fraud, some of whom were jailed.

While some doctors received community service orders and suspended sentences, most were simply required to pay back amounts owing to Medicare.

On average, GP’s provided 6139 services to 1866 patients, for a total Medicare amount of $212,268.  The total amount claimed by doctors during
2008/09 under Medicare was 14.3billion.

Currently, Medicare Australia closely “monitors” the 100 top-earning doctors but that does not automatically mean they are subject to audit.

Mr Bridge said if a doctor saw more than 80 patients on 20 or more days within a
12-month period they were deemed to have potentially engaged in inappropriate practice and would be considered for referral to the Director of Professional Services Review. This body is comprised f fellow doctors.

According to Medicare Australia, it retrieved $25 million in taxpayer money last year via compliance measures which included incorrect claiming.