Medicare Integrity

Posted on 24 October 2022

If you follow the media, you will no doubt have seen dozens of media stories in the last week questing the integrity of Medicare and allegations of widespread misuse by health professionals to the tune of 8 billion dollars. These allegations are alarming and should be investigated but from my perspective, while any form of Medicare fraud should be condemned and rectified, the real issue is the complexity, confusion, and issues with a dysfunctional Medicare system.

There needs to be a clear delineation between deliberate fraud - which is straight-up theft and should be punished - and human errors due to an overly complex system and an overworked health profession rather than a generic term of 'Medicare Rorting' applied to anything incorrectly processed. We need to provide health professionals and their support staff with a simpler way of providing Medicare services.

As many of you know, even government departments don’t understand Medicare billing rules. For example, AskMBS (a service to answer questions from Medicare providers) routinely gives out the wrong information to health professionals. Another example is government departments that instruct health professionals to break the law by asking health professionals to bulk bill clients and then claim the gap fee from that government agency. The complexity of Medicare is endless. If the elaborate rules around item numbers are not followed correctly, it is the health professional or client who is penalised. 

Medicare is chronically underfunded and riddled with needless complexity and inconsistencies. GPs are rebated less for mental health items than physical chronic disease items and psychology has a two-tier rebate system. The cost of two-tier has resulted in $150 million less in rebates last financial year alone.

Then there is the unpaid work of health professionals. Our current system relies on unpaid labour to function. For example, psychologists are required to provide reports to referrers, which is not a claimable activity. Many more unremunerated hours a day are spent coordinating services and care for clients, liaising with referrers, checking referral validity or providing pro bono work, where rebates or session allowances are insufficient. 

The intent behind Medicare is something we are proud of as a nation. However the execution of Medicare has been an elaborate mess for far too long - always at the expense of clients, hardworking health professionals and their support staff. But it can be and should be fixed. We welcome a review into how Medicare can be improved to reduce the administrative burden and red tape and to make it align with common sense to ensure the funds are going where they need to go, such as raising the Medicare rebate for the clients of all psychologists to $150, reducing the need for GP reviews after the initial 6 sessions and establishing a Medicare rebate for provisional psychologists.

If you are unsure about how to provide services under Medicare we have an entire section of our website dedicated to helping you, this includes billing education, quick reference guides, client claiming, referrer guides, referral validity information and much more. We also have two previous webinars with Dr Margaret Faux, Medicare Billing and Compliance and Medicare Compliance - record keeping for psychologists.

AAPi will continue to push for necessary change while supporting our members to navigate the behemoth that is Medicare.