The proposed legislation would put the spotlight on corporates who engage GPs and other clinicians.
A bill that would strengthen the compliance powers of the PSR and give the body greater flexibility in the way it handles inappropriate billing practice was re-introduced in the Senate last week.
Critics of the bill say while they support its broad intent to preserve the integrity of Medicare, it fails to support practitioners in achieving compliance and doesn’t even attempt to address the complexity of the Medicare system.
The bill was first introduced by the Coalition in October last year but lapsed when the election was called in April.
The changes include:
- An option for the PSR director to make section 92 agreements with non-clinicians and corporations, not just individual practitioners
- Sanctions against individuals and corporations that don’t produce documents or attend hearings when required
- An option for the PSR director to provide counselling on appropriate billing practice for the person under review
- Access to the records of practitioners who are not under review
- Expanded debt recovery powers, including from a deceased practitioner’s estate
Individual practitioners would not be named in section 92 agreements with corporations or other individuals who engage practitioners.
However, the bill would also create an exception to the requirement for section 92 agreements to remain confidential by allowing the director to publish details of an agreement if the person under review has not met any obligations.
“Historically, compliance activities have concentrated on the behaviour of individual practitioners, on the principle that practitioners are ultimately responsible for what is billed under their Medicare provider numbers,” Labor Senator Katy Gallagher said in introducing the bill.
“While this principle remains critical, the government needs to adapt its compliance arrangements to an environment where corporations are employing or otherwise engaging practitioners, and are increasingly involved in, and influencing the provision of, healthcare services.”
The bill would also allow the PSR director to include counselling on appropriate MBS billing as a specified action when reaching a section 92 agreement. Currently, specified actions include acknowledging inappropriate practice, receiving a formal reprimand, debt recovery and other restrictions such as suspending the practitioner’s ability to bill certain items.
New sanctions would be introduced for people under review who fail to attend committee hearings, give evidence or provide documents where required. Maximum penalties would be a fine of 150 penalty units, or $33,300 at current rates, for corporations, and 30 penalty units, or $6660 at current rates, for non-practitioner individuals.
The bill would also give the PSR access to the records of practitioners not under review, such as a colleague who refers a practitioner to the PSR.
Despite numerous objections during a Senate inquiry late last year, the Senate committee recommended the bill should pass without further amendment.
The committee acknowledged at the time that “submitters to this inquiry were generally supportive of the purpose of the bill” – to preserve the integrity of Medicare – “however, they raised some broader issues about the complexity of the Medicare system, compliance burdens for practitioners and the adequacy of support to achieve compliance”.
When the bill was introduced, the then AMA vice-president Dr Chris Moy told TMR the AMA had lobbied for the bill to include safeguards for practitioners, and had supported making corporations take more responsibility.
However, Dr Margaret Faux, a lawyer, medical billing expert and regular TMR columnist, told TMR the bill would not fix any of the serious structural problems in the system, and rather would strengthen the PSR in places where it had recently shown weakness – in other words, going after corporations.
“What we have is an outdated pay-and-chase model that is ineffective,” she said at the time. “We’re giving more power to a secret agency, when we know that the underlying equipment, [Medicare legislation], is completely faulty, and unable to be interpreted.
“So I predict that there will be more and more litigation against the PSR, and more doctors will rebel against this draconian system that is really becoming more and more medieval.”
