Watchdog Warns On Doctors Scamming Medicare
The Age
Monday January 15, 2007
A GROWING number of skin cancer clinics are performing unnecessary procedures to boost their profits, leaving patients with ugly scars and the taxpayer out of pocket, the watchdog on Medicare rorts warns.
And that's just one of the scams uncovered by the Government's Professional Services Review (PSR) and detailed in its latest report, which will be released today.The review has also raised concerns about the increasing trend of doctors seeing patients for a short or superficial consultation, but charging Medicare for an extended one, attracting rebates of about $60 or $120 - depending on which item is claimed - instead of the normal fee which is closer to $30. The scam has even been encouraged by the appearance of special software programs to help the doctor "tick boxes" quickly without properly examining a patient, PSR director Tony Webber said.Total Medicare rorts are likely to cost taxpayers more than $20 million a year - the amount Medicare Australia estimates it saves in a year from compliance activity. The cases dealt with by the PSR are only the tip of the iceberg - as a system of medical peer review, it looks only at instances where a doctor might be practising medicine inappropriately, while Medicare Australia also looks at such things as plain fraud and inappropriate billing. "There are certainly a wider group of practitioners involved in exploiting the system than get referred to the PSR," the general manager of Medicare Australia's Program Review Division, Colin Bridge, said, "that's only a slice of the action." Nonetheless, Mr Bridge warned that an increasing number of doctors would be caught by the PSR in coming years, following a major review of the way Medicare Australia refers cases to it. The number referred in 2005-06 had been unusually low, he said, because the review itself had delayed referrals and because of some administrative glitches in the system. Already the stream of referrals is beginning to flow, and in the first 10 days of this year, Medicare Australia referred four new cases to the PSR - half the number referred over all of last year. As well as looking at new referrals, the PSR continued to pursue doctors who had been in the scheme from past years.But now the scheme itself is under threat, with two medicos mounting a claim in the Federal Court that the PSR is unconstitutional.Dr Webber says he is confident that the constitutional challenge will amount to nothing, but even if it does, it has already stalled 13 cases the PSR is pursuing against doctors.In addition to skin cancer clinics and the use of extended consultation items, Dr Webber also raises concerns that some doctors are inappropriately prescribing medicines. Some had been unquestioningly prescribing Valium to patients who appeared to be addicted to it, and others had prescribed osteoarthritis medication for sports injuries, he said.Others were nabbed for ordering excessive medical tests. One doctor described in the report ordered significant number of medically unnecessary tests such as those for vitamin B12, folate and iron. It turned out he was using the tests to find vitamin deficiencies in his patients, then prescribing them vitamins from his own range. And then there is the old trick of charging for services never provided. One Melbourne doctor charged for so many services that he would have had to have worked up to 36 hours a day without a break. "Some of the behaviour we've seen has been fairly outrageous," Dr Webber said. "It's really only a minority who put profit before patient care, but sadly there will always be people like that." Dr Webber takes particular aim in his report at doctors who work in skin cancer clinics, warning they should ensure their training is up to scratch. Many such clinics are run not by dermatologists but by GPs without specialist training. There has been such a growth in the number of GP skin clinics that now one Australian university has started a special training course for those wanting to work in the area.CHRONIC CASES OF DODGY DOCTORS - Melbourne GP "Dr F" claimed so many items from Medicare that even they had been provided within the minimum time possible, he would have needed to work up to 36 hours on some days without a break.- Adelaide GP "Dr A" not only claimed a large number of items (15,018) but apparently performed an incredible range of services from diabetes and asthma care to removal of foreign objects from the cornea and the ear. Also "up-coded" some consultations to more complex ones.- On 132 different occasions, Perth GP "Dr B" was found to have issued more than one prescription for a particular drug to the same patient on the same day."There was considerable doubt as to whether ...patients were attending for Dr B's expertise in treating drug dependence or for preparedness to issue narcotic prescriptions".- Brisbane GP "Dr G", who had previously been counselled for over-servicing, ordered a significant number of medically unnecessary pathology tests for serum B12, folate and iron studies. Dr G had then prescribed his own vitamins for some patients.- Sydney GP "Dr E" was "the busiest (GP) in Australia at the time", claiming 28,102 services, or an average of 77 a day. That's almost twice the number of services claimed by other GPs in the highest claiming group. SOURCE: PROFESSIONAL SERVICES REVIEW REPORT TO THE PROFESSIONS 2005/2006.
© 2007 The Age