Medicare Audit Anxiety is on the increase!

According to a two-year survey, over 83% of doctors/providers believe that the care they provide to patients is affected by the uncertainty surrounding Medicare rules.

The Government has admitted for the first time there is a serious problem and it is harming patient care; see Health officials promise ‘authoritative’ answers from Ask MBS service.

Our response is “we told you so.”

We undertook a national survey into whether doctors feel that the current level of uncertainty of Medicare rules is affecting the care they are providing to their patients. We have completed our first round analysis of this survey and submitted the results to the Federal AMA, the PSR and the Federal Government.

The initial findings reveal that patient care is being affected by unclear Medicare rules. Of greater concern is that Medicare is not making it any easier for providers and practices to comply. This can only increase the risk to practices of a Medicare Audit and being unfairly accused of inappropriate billing. This damages morale and confidence in the system, and affects patients’ access to clinically relevant fair care.

We commenced this unique Australian national survey in July 2019 and received 215 responses.

We found that:

  1. 96% of providers do not receive clear, accurate and consistent information from Medicare.
  2. Over 83% of providers feel the uncertainty of Medicare rules affects the care they provide.
  3. 84% indicated that centralised, commonly-agreed health care standards are needed. 
  4. Over 64% indicated the government, professional bodies and/or an independent entity should together establish and enforce these health care standards.
  5. Over 80% of providers used clinical resources and guidelines that were not Medicare audit-proof. Over 42% were unaware they were not audit-proof.
  6. Over 70% of providers reported that, following a query to Medicare, they had to wait longer than a week to receive an answer. Over 38% never received an appropriate or timely answer.

We distributed these preliminary results to key professional bodies in 2018.

Despite the overwhelming evidence in this survey, and a survey of over 300 practice managers (see the following video) we are yet to receive a response.

This video, of practice managers at a 2017 national practice manager conference, shows that practice managers indicated (nearly unanimously) there is an ongoing and serious problem with Medicare answering their questions clearly and on a timely basis.

Where to from here?

1. Federal Court Action will be addressing this issue. Dr Karmakar, a high-profile GP trainee and author, is seeking an answer from the Federal Courts on whether providers are being unfairly prosecuted, which she argues is harming patient care. She is not claiming damages; rather, it is Constitutional public interest case challenge, one that is supported by Dr Mukesh Haikerwal, Julian Burnside QC, law firm Platinum Lawyers and many other high-profile practitioners.See PSR facing High Court Challenge  and David and Goliath Medical Billing Investigations and the Silencing of Doctors (thanks to Julian Burnside QC who assisted with this article).

Please support Dr Karmakar at Change.org Page and share it with your Colleagues. Your support counts in front of a Federal Court judge.

2. We need a positive and practical solution to establish a not-for-profit independent healthcare and ethics board. For a solution, see To reduce fatal   medical errors look to the world of accountancy. Start the discussion and contact us for further information if you would like to be more involved.

3. If you are a provider or practice staff member, please complete this important five-minute survey, the Medicare Complexity Survey. Please complete it and share it with your colleagues. We collect this (de-identified) data for the Federal Health Minister and the High Court of Australia.

Here is a specific and detailed breakdown of the survey responses.

96% of providers do not receive accurate and consistent information from Medicare.

Over 83% of providers believe the uncertainty of Medicare rules affects the care they provide.

84% indicated that centralised commonly agreed health care standards are needed.

Over 64% indicated such a function should be managed by the government and professional bodies and/or an independent entity.

Over 80% of providers consulted clinical guidelines and resources that were not Medicare audit-proof. Over 42% did not know they weren’t audit proof.

Over 70% of providers had to wait longer than a week to receive an answer from Medicare. Over 38% never received an appropriate or timely answer.

For more information contact us at Health and Life pa@healthandlife.com.au .

(c)Health and Life Pty Ltd

For more insights visit our blog.

About me: David Dahm BA (Acc.), CA., FCPA, CTA, FFin, CPM, FAAPM, FAIM, FGLF.

Chartered Accountant, Chartered Tax Adviser, Registered Tax Agent, Former AGPAL Surveyor 10 years of service

David Dahm is CEO and founder of the national medical and healthcare chartered accounting firm Health and Life and global Founder and CEO of the not for profit project the International Healthcare Standards and Ethics Board (www.ihseb.org)

After a serious work related car accident in 1989, and nine operations later I continue to be a patient and provider advocate. I enter my third decade as a national Chartered Accountant for Medical and Healthcare practices in Australia. I am a former 10-year Australian General Practice Accreditation surveyor. I come from a medico family. I have served on the AAPM national Board and was the inaugural national Chair of the Certified Practice Manager CPM post nominal. I continue to provide accounting tax and practice management advice to many practices all over Australia.

You know who you are and I thank you for this real honour and privilege to serve you and your community through you. Note, I am not a lawyer please seek appropriate legal and accounting advice. This information is for general information and discussion only.

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