18 May 2021

So you’re being audited by Medicare …

Finance KnowCents Medicare

Increasingly I am getting distressed phone calls from colleagues going through the MBS auditing process.

Some people who call me are halfway through the process, some are nearly at the end, but the common theme is the feeling of innate unfairness and of despair. Most clinicians never intentionally defraud the system. Most of us are hard-working professionals trying to make the lives of our patients better and, of course, feeling some pride and joy about the lifestyles we are able to lead from all the hard work we have done.

Without getting into the technical and legal details of this process, I wanted to share with you a few Dos and Don’ts I have learned over the years from personal experience – the things that will help you stay sane and able to keep working.

Do

The moment you are contacted by the auditors-being the PRP or the PSR (usually you do not get contacted by the PSR unless you have been referred to them), the first things you should do are to:

1) Notify your medical indemnity that this contact has been made and initiate a file.

2) Consider contacting and seeking legal advice external to your medical defence-based lawyers from the beginning to involve them in the process.

3) Choose your external contact carefully as very few law firms really specialise in and understand this process.

4) If you are not satisfied with the support you are getting, contact me at  info@ahpas.com.au.

5) Unless you have truly, maliciously defrauded Medicare, breathe deeply, take your own pulse and repeat the following words: “I am going to be ok. I am not a bad doctor. I have many colleagues and professionals who will help and guide me through this. I am not alone, and I will be fine.” Then go and make yourself your favourite drink, hug your family and continue doing the amazing work you all do.

Don’t

1) Panic. This is not a difficult resus situation where we are dealing with life and death. This is merely a process of accountability with some flaws that make it feel, taste and sound extremely unfair. It is ultimately just an administrative process that is designed to look very scary to ensure compliance through deterrence.

2) Hide it from your colleagues and friends. There is no shame in this happening, and if your employer or colleagues are ashamed or discriminate against you for this, then take it as an opportunity to know who your real colleagues and friends are. This is very important because one of the strongest defences you will have is those peers who practise the same way as you do and who are willing to support you regarding your conduct and practice. Isolation by shame and guilt by association is what the authorities have inadvertently created and leveraged over the years. United we are much stronger.

The caveat here is Section 106ZR of the Health Insurance Act, which restricts what you can discuss with others once proceedings are under way.

3) Write long, nasty, emotional emails to the authorities and/or be rude on the phone to them. These people are just doing their job and this will only make you look like a donkey, so stop. It’s like what we have to do when we deal with nasty patients. Maintain your professional standards, never lose your cool, and if you feel self-control slipping, say: “I am not able to answer your questions at this stage, I would like to take what you said on notice and get back to you in due course. In the meantime, could you kindly put everything in writing for me and my legal counsel and I will respond to it in detail.”

4) Keep harassing your lawyer with hundreds of emails and phone calls – good legal counsel will contact you when it is necessary. The more you interrupt them, the less time they will have to work on your matter. If you are worried about specific things, of course call/email them. If not, let them do their job, and remember, legally your solicitors/barristers cannot do anything until and unless they have specific consent and instructions from you. They will never leave you out of the loop. This is a professional obligation. You will have the opportunity to ask questions, dispute their thought process and discuss when the time comes.

That said, of course, if you don’t like what you are hearing and you realise the people you have chosen are not acting in your best interest, ditch them and get a new team together whom you can trust.

5) Neglect your finances and insurances – make sure you look into this. I hear of so many GPs and other colleagues who have no idea how to properly structure their finances and insurance schemes. If you are ever audited and if you ever have to go as far as court, you want to make sure that your family and assets are protected adequately. It is a very stressful and time-consuming affair, so make sure those areas of weaknesses are covered off and reviewed on a regular basis.

Again, AHPAS is here to help, so don’t hesitate to contact us.

Dr Anchita Karmakar is a GP registrar and CEO of AHPAS. Her Federal Court case against the PSR is awaiting judgment.

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