11 March 2021

FACT CHECK: Have 30,000 GPs misused telehealth?

ACRRM AMA MBS RACGP Telehealth TheHill

The government is warming up to send compliance letters to GPs about their use of the temporary telehealth item numbers, the RACGP says.

The campaign could begin as early as this month, according to a piece on the RACGP’s news website newsGP, written by Dr Michael Wright, Chair of the RACGP Expert Committee on Funding and Health System Reform.

He wrote that the RACGP had been informed that following a Medicare Benefits Scheme analysis by the Department of Health “30,000 GPs had potentially breached telehealth MBS rules”.

Dr Wright and president Dr Karen Price had conveyed their “concerns” to the DoH about a potentially huge compliance campaign in the middle of the vaccine rollout.

It bodes ill for the long-awaited transition of the temporary telehealth item numbers into permanent Medicare features if the department believes nearly all GPs have abused them.

But the idea that the vast majority of the profession has been inappropriately billing telehealth items seems somewhat implausible.

As at December 2020, the Medical Board of Australia recognised about 29,000 specialist general practitioners. And national data from 2018 suggests there is an additional 4500 non-VR GPs.

This would mean that the Department of Health plans to send compliance letters to almost 90% of the profession.

Dr Wright wrote that the college understood that the majority of breaches centred around the requirement that a patient must have seen a doctor face-to-face at least once in a 12-month period to qualify for bulk-billed telehealth services at the same practice. This is a restriction the college lobbied hard for.

The RACGP declined to confirm its own report that 30,000 GPs would be subject to receiving a compliance letter in the coming months, directing TMR to the DoH to confirm the figure.

We had already asked the DoH about the number of practitioners implicated by their investigation – whether it was really 30,000 individuals or that was the number of claims – and whether it was appropriate in the midst of the sensitive vaccine rollout, but there was no response before publication.

ACRRM president Dr Sarah Chalmers told TMR that her feeling was that while the number of non-compliant consultations may have been about 30,000, fewer than 10,000 practitioners had come under scrutiny. 

“My understanding is that [the Department of Health] did an audit and worked out how many people had been non-compliant and then tried to stratify how significant the breaches were,” she said.

A majority of ACRRM members are located in Modified Monash Model areas 3-7. The college understands that the number of compliance breaches in rural and remote settings are minimal, and the majority is focused on metropolitan practitioners.

“I assume that’s because it was the major metropolitan areas that have had the longest periods of lockdown,” Dr Chalmers said.

She acknowledged that GPs act as the gatekeepers of Medicare, and that there was a responsibility to comply to item descriptors.

“But in terms of the compliance letters at the moment, given the [telehealth items] were introduced in an emergency situation, the compliance letters should be more about education,” she said.

“I think it would be reasonable to be pointing out to people that through the audit process they had been not been fully compliant.

“I haven’t seen a copy of the letter, but I would be hoping that there wouldn’t be anything punitive in there.”

Dr Chalmers said that ACRRM would also like to see the temporary telehealth item numbers extended, past their expiry date at the end of the month.  

“There’s a fine line because we do need to make sure that all practitioners are doing the right thing but at the same time we want the continuation of telehealth, and we want it done in a responsible way,” she said.

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11 Comments on "FACT CHECK: Have 30,000 GPs misused telehealth?"

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Chris Denz
Guest
Chris Denz
1 month 29 days ago

This report is rubbish and the numbers are bogus, and shame on anybody for publishing and/or reposting unsubstantiated rubbish.

Penny Durham
Admin
1 month 29 days ago

The college sent this information to all its members via its news service, then declined to either confirm or correct the number, and it was reported in other media, but we’re not to question it? Stand by for a further clarification from the DoH.

Oliver Frank
Guest
Oliver Frank
1 month 29 days ago
The ‘face to face within the last 12 months’ thing is a clumsy and inadequate solution to the problem that we have that Australians are eligible to receive Medicare benefits to consult GPs in as many different practices as they wish, even in a single day, with none of those GPs having any obligation to communicate with any of the other GPs, or to seek and find existing recent clinical information about the patient. The best solution to this problem is that Australians will receive Medicare benefits only for services provided at, by or on referral from only the one… Read more »
ANDREW BAIRD
Member
ANDREW BAIRD
1 month 29 days ago
Thank you, Oliver, I agree. The Voluntary Patient Enrolment (VPE) initiative will go some way towards achieving a one patient-one practice system. The VPE is for people aged 70 and over, and for First Nations’ people aged 50 and over. It was due to be introduced last year, but the introduction has been delayed … due to the pandemic. VPE is not quite the same as patient registration. VPE is, as the name indicates, ‘voluntary’, and it only applies to some patients. It’s nowhere near a full registration system (eg like in the UK). The ‘pre-existing relationship’ criterion is nonsense.… Read more »
Zenon Gruba
Guest
Zenon Gruba
1 month 29 days ago

I suggest that this is another piece of medicare wanting to save money, but stealing it back from GPs. They are too scared to that the voting patient public.
When a GPs going to learn. He pays the piper decides the noise.
Stop billing medicare for anything. That’s an agreement between the Feds and voters. It has nothing to do with patients and DRS.

ANDREW BAIRD
Member
ANDREW BAIRD
1 month 29 days ago
I am confused. If you submit a claim for a service that is not eligible for a Medicare benefit (patient last seen at GP’s Clinic > 12 months ago ) , doesn’t the claim automatically get rejected by Medicare? Surely Medicare has algorithms set up to pick up patients who are not eligible, and to reject the claim? Surely Medicare doesn’t pay out on non-eligible claims?? Yes, RACGP and AMA pushed for this as a way to stymie the pop-up telehealth providers. Looks like RACGP and AMA may have shot themselves in the foot on this one. (Not sure if… Read more »
Joyce Hyde
Guest
Joyce Hyde
1 month 29 days ago

Unfortunately, Medicare doesn’t have very comprehensive “automatic checks algorithms” – there isn’t any algorithm set up for telehealth eligibility (that I’m aware of anyway!)

ANDREW BAIRD
Member
ANDREW BAIRD
1 month 29 days ago

Patients who are in lockdown, in quarantine (as contacts or travellers), or in isolation (for COVID-19) are eligible for Medicare benefits for phone and video services by GPs.

Medicare will ‘know’ if a patient is in lockdown (based on date of service and postcode). However, how does Medicare ‘know’ if a patient is in quarantine or isolation? Are GPs supposed to annotate the Medicare billing with this information?

ANDREW BAIRD
Member
ANDREW BAIRD
1 month 29 days ago
Thanks Joyce. I just assumed that there would be algorithms for this, It’s quite astounding to learn that there are not any algorithms for this. I think ‘I thought there was an algorithm to check this’ will be a reasonable defence for any GP who gets caught for billing Medicare for a non-eligible patient. I usually – but not always – check eligibility for telehealth. I tend to rely on the Practice Manager and Receptionists to pick this up, they have been informed about The Rules. Still, that won’t stand up as a defence for Medicare.
Ruth Ratner
Guest
Ruth Ratner
1 month 29 days ago

I did wonder how the after hours doctor could charge my patient for a telehealth consultation. It is very unlikely he had seen her in the last 12 months.

ANDREW BAIRD
Member
ANDREW BAIRD
1 month 29 days ago

If your Practice has an agreement with a SuperDoc After-Hours service, then if the patient has been seen at your Clinic in the previous 12 months, and the patient sees a Doctor from SuperDoc After-Hours service, the telehealth consultation/attendance is eligible for Medicare benefits.

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