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This was published 7 months ago
Health giant refuses to open patient files for Medicare probe
By Sean Parnell
The Medicare watchdog has asked a Federal Court judge to examine why Queensland Diagnostic Imaging is not allowing an official audit of its medical practices and billing.
In documents filed in court, the Professional Services Review has argued the company, a subsidiary of Healius, “refused or failed to comply with a notice” issued by one of its investigative committees in December.
Queensland Diagnostic Imaging, a subsidiary of health giant Healius, has been taken to court by the Medicare watchdog.Credit: Nic Walker
Such a scenario would normally trigger a ban on practitioners being able to bill Medicare, which in this case would have seen higher fees or a reduction in services at dozens of imaging centres across Queensland.
However, given the nature of the investigation, and the potential ramifications, the judge has agreed to stay any such action until three weeks after final orders have been made.
Healius, which also offers diagnostic imaging under the Lumus banner, declined to say how many centres and practitioners were caught up in the investigation.
A PSR spokesman also declined to comment while there was an “ongoing inquiry”.
But the spokesman confirmed the committee was looking at “whether QDI has engaged in inappropriate practice by knowingly, recklessly or negligently, causing or permitting one or more practitioners employed or otherwise engaged by QDI to engage in inappropriate practice”.
“At this time, there is no risk that Medicare benefits will not be payable for services provided by practitioners providing services through QDI, due to the operation of the stay of the court that is in place,” he said.
The PSR has previously raised concern that patients are being given scans they don’t need, or without the clinical justification. In several cases, individual practitioners have had to repay hundreds of thousands of dollars in Medicare fees.
The PSR can place limits on Medicare billing and normally recovers about $20 million from practitioners and companies each year. It also has the power to refer practitioners for disciplinary action and recovers.
More than 5000 diagnostic imaging or radiation oncology practices are registered with Medicare.
In September, Healius was ordered to pay a $1.65 million penalty, and legal costs of $200,000, for breaking the rules around the co-location of pathology collection centres at medical practices.
Hearings in the latest case have been scheduled for July.