Doctors to refund $49m in rebates

The amount of Medicare money found to have been misused by doctors surged 68 per cent last year.

Public hospitals will be subjected to increased scrutiny to ensure they are not double-­dipping by billing Medicare for services meant to be funded under state budgets.

The amount of Medicare money found to have been misused by doctors surged 68 per cent last year, when the Department of Health demanded $48.7 million in rebates be repaid to help keep the budget sustainable.

Tougher compliance initi­atives have seen a tenfold increase in the amount ordered to be repaid by doctors over the past five years. In 2016-17, about $29m was raised as debts to Medicare, but the subsequent federal budget foreshadowed an extra $103.8m over four years as the government sought to tighten control over spending.

Last year, for the first time, the department was also able to demonstrate $148.5m in savings attributable to “behaviour change” following interventions such as letters to doctors questioning why their billing differed from their peers.

Initially, the department thought that strategy would achieve $13m in savings, but so-called “nudge economics” has proved successful across government. In health, it will allow for more work on complex Medicare investigations.

The Australian has revealed how the government has changed legislation, and encouraged the department to work with law enforcement agencies, to pursue much bigger cases.

This is expected to have an impact throughout the system.

The department has asked the Australian Federal Police whether the Proceeds of Crime Act — commonly used to restrain the assets of drug dealers, money-launderers and fraudsters — could be used to pursue errant doctors and corporations.

Its debt recovery rate is traditionally low compared with other departments, but rose to 45 per cent last year.

From next July, the department will also be able to hold clinics, hospitals or corporate entities responsible for debts incurred under an individual’s Medicare provider number.

The first case was referred to the Professional Ser­vices Review before the legislative amendments were passed, while the Commonwealth Director of Public Prosecutions has noted “an increase in the complexity of Medifraud referrals received from the Department of Health, including medical practices operating via corporate structures and claiming benefits they are not entitled to”.