FACT CHECK: Have 30,000 GPs misused telehealth?

The number seems implausible, given it would be the majority of practitioners who offered these services during the pandemic.

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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.

If 75%+ of GPs have ‘misused’ telehealth then there’s clearly a problem with the system and the rules – not the GPs.

— QLD Country GP (@QLDCountryGP) March 11, 2021

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.

It’s seems like doctors are trying to provide health care, remotely, during a pandemic

— Dr Brad McKay (@DrBradMcKay) March 10, 2021

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.