GPs denied test results as clinics claim Medicare funds

An SEQ doctor has accused Queensland’s state-run bulk-billing clinics of breaching Medicare rules by billing for scans without emailing reports to referring doctors, risking patient safety.

Logan GP Dr Thomas Lyons said results of critical diagnostic tests were not being sent back to doctors even though the state-run clinics were claiming for the service. Picture: Judith Kerr

A Logan doctor has accused Queensland’s state-run bulk-billing urgent care clinics of potentially rorting Medicare by failing to return scan results to referring GPs while still claiming federal payments.

Dr Thomas Lyons said the clinics, created to ease pressure on hospitals, were not complying with Medicare Benefits Schedule rules that require imaging reports, such as X-rays and ultrasounds, to be returned to the ordering doctor.

State-run bulk-billing clinics carry out the tests and send them to specialists at state-run hospitals for diagnostics but GPS and referring doctors are not receiving the results, despite the taxpayer paying for the service.

“The federal government’s Medicare still pays the state government for doing the scans,” Dr Lyons said.

“We order the reports but we will never get them as the state-run hospitals will not release the medical imaging results to doctors outside the hospital.

“State hospitals, such as Logan Hospital, can send blood work results but not X-rays or other scans and my doctor colleagues have all been advised that the state hospitals will not forward those results.

“When we deal with private centres such as Qscan, we know with absolute certainty that we will receive the X-ray results because the diagnostics are not completed at a government hospital.”

The previous Labor state government set up the bulk-billing clinics to take the pressure off state-run hospitals. Picture: Judith Kerr

Dr Lyons said the issue first came to light after a mother brought her injured son to him following a school incident. The boy was sent to the Browns Plains urgent care clinic with instructions that the mother would be contacted if his arm was broken.

“However, we never received an emailed diagnostics report – so could not advise the mother, even though the scans had been completed,” he said.

Federal Medicare rules require that imaging providers send a written report back to the referrer, which is logged in the state’s internal database, called The Viewer, before a service can be billed.

“Logging in takes time, and unless you know to look for a scan, you’d never know it’s there,” Dr Lyons said.

“The results don’t integrate into the patient’s file, so five years from now, we won’t have a complete medical history for the patient either.

“It isn’t just a paperwork issue, it’s a clinical risk, and the system is failing patients.

“They’re not fulfilling their legal obligation to return the report to the referrer, yet they’re billing Medicare for it, with that money going back to the state government.”

Specialists at the state-run Logan Hospital carry out diagnostics on scans sent to them from the bulk-billing clinics but GPs say they never receive the results.

Dr Lyons’s concerns were raised with Services Australia, the Department of Human Services, Senator Katy Gallagher, and Queensland Health, before the Department of Health responded.

A department spokesperson said suspected incorrect Medicare billing was taken “very seriously” and encouraged doctors to report it via the department’s tip-off portal.

“Medicare-funded diagnostic imaging services, such as X-rays, MRIs and CT scans, could not be billed to the federal government unless a written report was provided to the requesting practitioner,” the spokesperson said.

“This requirement must be met before a Medicare billing claim can be submitted.

“We will review any concerns in accordance with compliance assessment procedures.

“Patients sometimes elect not to obtain requested tests, or do not obtain them in the time frame expected by the requesting practitioner.”

The Browns Plains clinic is one of several across Queensland, including locations in Woolloongabba, Townsville, Cairns, Gold Coast, Toowoomba, Rockhampton, Hervey Bay, Bundaberg, Ipswich and Murrumba Downs.