Hundreds of GPs warned over incorrect Medicare billing of chronic disease patients

Patients are missing out on subsidised medical appointments for chronic diseases due to incorrect Medicare billing by GPs, prompting the Australian health department to issue hundreds of warnings.

Throughout February compliance letters were sent to 596 healthcare providers who regularly claimed subsidies from the government for developing or reviewing a chronic disease management plan for their patients and, for the same appointment, also claimed a separate subsidy for providing chronic disease management and support services.

The development and review of the chronic disease management plan already includes subsidies for management and support services, making it unnecessary for GPs to claim for this service on top.

Chronic disease patients are entitled to five subsidised appointments a calendar year for chronic disease management and support services on top of their subsidised and more comprehensive appointment for a chronic disease management plan and review. This is to help support them between those major appointments.

If their GP is claiming the support and management service at the same time as their appointment for their chronic disease plan or review, the patient then loses the opportunity to book a separate and additional subsidised appointment.

Subsidies are claimed by GPs under the Medicare benefits schedule (MBS), with each service attached to an item number.

No penalty was given to doctors found to be regularly co-claiming support services with chronic disease management plan services, he said, but the letters asked healthcare providers to review their MBS item claims and ensure they were doing the right thing.

The compliance action follows PhD research from a lawyer and nurse, Dr Margaret Faux, who undertook a comprehensive review of Medicare and found illegal or wrongful billing by doctors and other health providers was rampant. Often this wrongful billing was accidental, she found, as the Medicare system was so complex it was hard for doctors to comply.

In response, a health department spokesman told Guardian Australia the department was aware of certain circumstances where the item numbers could be legitimately claimed on the same day but those GPs were not the target of the compliance letters.

Information about potential non-compliance was also received through tipoffs, and from other agencies and stakeholders, and peak medical bodies were consulted in the design of compliance activities, he said.