Hundreds of doctors audited for rorting Medicare’s telehealth

Doctors are being audited for potentially breaching Medicare rules by incorrectly claiming rebates for more than 300 telehealth consultations.

TWO dozen doctors are being audited for potentially breaching Medicare rules by incorrectly claiming rebates for more than 300 telehealth consultations.

A further 200 doctors fessed up to incorrect billing new Medicare items, after a self review, and had to pay the money back, the Department of Health has revealed.

A requirement that doctors can only have a telehealth consult with a patient they had seen in person in the last 12 months has turned out to be a key stumbling block in the new system.

And the Royal Australian College of General Practitioners (RACGP) is calling the crackdown “officious” and said it was causing “unnecessary stress and anxiety for many GPs”.

It has written an open letter to the Department of Health asking for the breaches to be reviewed on a case-by-case basis.

Many GPs had fallen outside of the strict scope of the rules because long-term patients, who had had face-to-face appointments for many years, resorted to telehealth consultations in early 2020 due to pandemic lockdowns, RACGP president Dr Karen Price said.

One GP gave an example of an adolescent patient they were treating via telehealth who was suicidal, she said.

The requirement that telehealth items could only apply to existing patients of a medical practice was put in place at the behest of doctors who wanted to prevent “pop-up” clinics taking advantage of the new rebates and stealing their patients.

The crackdown has been causing “unnecessary stress and anxiety for many GPs”.

Many GPs believed the intention of the Medicare Benefits Scheme requirement was that they simply had to prove that the person had been a patient of the practice in the 12 months prior to the telehealth items being created, Dr Price said.

“That was the intention of these rules – to ensure people using telehealth were ongoing patients of the practice. The problem is the Department overreached and targeted GPs who are only working in good faith trying to help their patients via telehealth during a very stressful and challenging time, especially in Victoria,” Dr Price said.

“Enough is enough, common sense must prevail because GPs and patients deserve better. The focus of general practice should be on the vaccine rollout, not dealing with an unnecessary bureaucratic headache that was completely avoidable.”

A spokesperson from the Department of Health said analysis of Medicare claiming data showed more than 85,000 health care providers have provided Medicare telehealth services since they were allowed in March 2020.

The new system was introduced to help people receive health care during lockdowns.

Prime Minster Scott Morrison revealed on Sunday that 66.8 million telehealth services had been delivered to 14.6 million patients and almost $3.4 billion in benefits has been paid.

The new system was introduced to help people receive health care during lockdowns and social distancing rules during the pandemic.

The Department of Health has written to around 400 doctors asking that they self-review their claiming and pay back any money they were not entitled to.

Approximately half these GPs voluntarily acknowledged incorrect billing of telehealth services.

A further 23 GPs are being audited and “may not have met the Medicare claiming rules on more than 300 occasions,” the Department of Health spokesperson said.

The audits were still ongoing and to date no decisions or penalties had been applied.

“The overwhelming majority of health care providers are doing the right thing. No other providers have been given warning or penalties at this time,” the spokesperson said.