Transparency on specialist Medicare audits still lacking

GPs have renewed calls for specialists to be brought under the same level of scrutiny as general practice through fairer targeting of Medicare audits across the health professions.

AMA council of general practice chair Dr Rod Pearce said despite Medicare’s efforts to introduce such parity, GPs were still disproportionately audited and subsequently referred to the Professional Services Review (PSR).

A 2007 review of the PSR found that fewer than 5% of all practitioners referred to the body between 1999 and 2007 were specialists (MO, 5 October 2007), despite the fact that they accounted for more than 50% of Medicare expenditure.

The review recommended better monitoring of specialist data. However, two years later, it’s unclear whether the number of specialists investigated has increased significantly.

According to Medicare figures, 950 audits were completed in the first four months of 2009, with 328 medical professionals identified as claiming incorrectly. But at the time of going to press, Medicare was unable to provide Medical Observer with a breakdown of how many specialists were included in this number.

Medicare Australia’s program review division general manager Colin Bridge said in the past 12 months Medicare had begun engaging with representatives from various specialty groups to better understand and analyse specialist practice profiles.

“In doing this, Medicare Australia is intending to be able to identify behaviour which could be classified as out of alignment with that of a specialist’s peers. This may raise concerns about appropriate practice,” he said.

Mr Bridge said Medicare was analysing compliance concerns regarding the billing of time-based items by anaesthetists and psychiatrists and would consider audits later this year.

The latest calls follow fresh concerns raised by GPs at the AMA’s annual conference over Medicare’s increased auditing activities, which will rise by 400% this year.

“If there is evidence that [GPs are] a particular problem and are not doing the right thing, then we would like to see it,” Dr Pearce said. “If there isn’t, then it... should be proportionate.”

Queensland GP Dr Kirsten Price said that, while she understood the need for compliance measures, it appeared Medicare was setting double standards.

“You can be... sure there are other [specialties] rorting the system too – we do need to track those people down,” she said.