PSR gets wider powers under new law

With corporate medicine growing in influence, Medicare now has greater capability to investigate suspected non-compliance.

The PSR can now strike compliance agreements with corporations and non-clinicians deemed to have engaged in inappropriate practice – not just with individual practitioners – after parliament passed a legislative amendment on Monday.

The changes to the Health Insurance Act also include: 

• 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 compliance agreements with corporations or other individuals who engage practitioners.

While expected, the bill’s passage comes not long after Health Minister Mark Butler commissioned an independent inquiry into MBS compliance. The inquiry was in response to a Nine newspapers / ABC 7.30 joint “investigation” that alleged doctors were overcharging Medicare by $8 billion a year through inappropriate billing, over-servicing or even fraud.

Mr Butler has entirely rejected the media claims.

Former paediatric neurologist and independent member for Kooyong, Dr Monique Ryan, backed the bill, saying it was “not particularly consequential”. However, she was also concerned that it reflected “several aspects of the systemic malaise of our public healthcare system”.

Dr Ryan told the House of Representatives the RACGP had raised its own concerns about the procedural fairness and transparency of the bill’s proposals.

“Firstly, this bill proposes that the director of the PSR should be able to enter into agreements with non-practitioners and bodies corporate,” Dr Ryan said. “While most general practices are privately-owned by GPs, there are many other ownership models, including shareholder-owned, publicly listed companies.

“This government needs to have different regulatory expectations of corporate entities of varying sizes and resources as compared to smaller individual practices. There is with this bill a real risk of increased compliance burden on smaller practices, particularly in rural areas, which could reduce the capacity for those doctors to provide high-quality care to patients while their practices are under investigation.”

Dr Ryan added that the bill’s increased penalties for refusal or failure to produce documents or information “suggests a focus on cost recovery and punitive approaches to compliance”. This, she said, may exacerbate existing concerns among GPs about the intent of compliance activities.

Expansion of the power of the director to publish information about a person who has not fulfilled their obligations under a section 92 agreement was a breach of privacy that could have a significant impact on individual practitioners, she added. “The increase in sanctions and the broader debt collecting powers prescribed by this bill reflect a really punitive approach to compliance, rather than an educator focus helping practitioners to bill correctly.”

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GPs say increased Medicare compliance activities and the fear of being audited are distracting them from their primary focus, “which is and should always be the delivery of high-quality, patient-centred care”, Dr Ryan said. “This fear creates a significant conflict between the administrative obligations that GPs need to adhere to, as set out by this legislation, and their commitment to patient care.”

In an impassioned speech, she called on the government to support Australian GPs, including by making general practice more attractive to medical graduates.

“We need to stop accusing overworked, often underpaid professionals of widespread systemic abuse of the Medicare system,” she added.

Dr Ryan also told the house that if underbilling were taken into account, Medicare would be found to be rorting GPs.

Former paediatrician and Labor member for Macarthur, Dr Mike Freelander, also backed the bill and recommended the House listen to concerns about Medicare compliance raised by former PSR director Dr Tony Webber, who appeared on 7.30 as part of the Medicare rorts investigation.

“The previous manager of the compliance system, Professor Julie Quinlivan, has also given some very good information about how the compliance system could be improved,” Dr Freelander said.

Professor Quinlivan currently faces a misfeasance suit brought against her for knowingly not taking into account an ophthalmologist’s submission before establishing a PSR committee to investigate him.