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Reforms to Medicare compliance– firmer but fairer?

Law reforms introduced from 1 July 2018 have given Medicare stronger debt recovery powers. The legislation also provides for fairer approaches to compliance, by apportioning responsibility for overpayments between both doctors and their employers or contractors, including public hospitals.

Minister for Health, Greg Hunt said the legislation aims to deal with the “very, very small number of outliers” who don’t comply, at the same time acknowledging “the outstanding degree of integrity” among the medical workforce when the Act was being reviewed by Parliament.

Recovering overpayment debts

Doctors with a debt to the Commonwealth arising from Medicare compliance activities will be encouraged to enter into a repayment plan within 90 days.

Medicare also has a new power to require the production of documents and information related to the financial affairs of doctors with a debt.

Compliance – a shared responsibility

From 1 July 2018, the Professional Services Review Committees are empowered to make findings of inappropriate practice against persons or officers of body corporates who employ “or otherwise engage” doctors. This includes practice owners and officers of corporate practices. The consequences of a finding for a person found guilty of inappropriate practice in that way includes the repayment of the whole or part of the Medicare benefits paid for a service, notwithstanding the service was rendered by an ‘associated person’ (such as the providing doctor) and the benefit was paid to an ‘associated person’. 

Also, from 1 July 2019, a Shared Debt Recovery Scheme will apply to the recovery of debts arising from making a false or misleading statement, e.g. a claim for benefit. The Scheme will allow Medicare to make a determination about the proportional responsibility of the primary debtor (the providing practitioner) and a secondary debtor. The secondary debtor may be a person or body corporate such as a hospital, corporation or practice.

What should you do?

It is in the interests of both individual providers and those who employ or otherwise engage them to cooperate, to ensure all documents related to claims for Medicare benefits are complete and accurate.

The reforms do not diminish the provider’s primary responsibility for the services they provide. Providers should continue to ensure that they are knowledgeable about item descriptors and explanatory notes for Medicare Benefits Schedule services they provide. Providers should always determine what items are billed in their name and take every care to ensure documents submitted to Medicare under their provider number are accurate and not misleading.

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(Source: Avant)

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