< BACK TO LATEST NEWS

Joint responsibility for Medicare repayments

19 June 2019 | Avant media

With the Shared Debt Recovery Scheme coming into effect on 1 July 2019 as part of an increased focus on Medicare compliance, it’s important for both doctors and practices to understand Medicare Benefits Schedule (MBS) billing requirements.

Medicare ‘review and act’ letters

As part of its compliance strategies, the Department of Health is taking a new behavioural economics-driven approach to encourage health professionals to improve their practice, primarily through sending out ‘review and act’ letters.

These letters are being sent to groups of health professionals who have higher billing or prescribing rates on particular MBS and Pharmaceutical Benefits Scheme items compared to their peers. The letters provide education on appropriate practices and require doctors to review their billings or prescribing. If a doctor has billed incorrectly, they are required to notify Medicare and pay back any incorrect billings.

Medicare Shared Debt Recovery Scheme

From 1 July, under the new Shared Debt Recovery Scheme practice owners could be liable for Medicare debts owed by doctors who are contracted or engaged to work within the practice.  

Medicare will have the power to apportion debts arising from false or misleading statements (e.g. claim for benefit) between the individual doctor and a secondary debtor, such as a practice or corporation.

Under the new legislation Medicare can make a shared debt determination where it is reasonably believed the:

  1. practice could have controlled or influenced the circumstances that led to the making of the false or misleading statement
  2. practice directly or indirectly obtained a financial benefit from the making of the false or misleading statement
  3. circumstances of the case make it fair and reasonable for the determination to be made. 

When a doctor is first contacted about an audit, they will be asked if they would like to be considered for a shared debt determination. The doctor will be asked to produce documents in relation to the services claimed and information about relevant employment, contractual or financial arrangements. If a possible secondary debtor is identified, they will also be asked to provide information.

A shared debt determination will be the decision of the audit officer about whether there is an audit debt, whether it should be shared between the two parties and what the split should be. It has been decided that the split would be 65% for the doctor (the primary debtor) and 35% for the practice or organisation (the secondary debtor). However, the parties can make submissions if they believe the proportion should be different.  

Under the Scheme, if either party applies for a review of the decision, a review will be undertaken by a review officer, working on behalf of the Chief Executive Medicare.

Advocating for you

Avant has made a submission on the Shared Debt Recovery Scheme and is actively participating in the consultation process, to ensure clarity on its application and that responsibility is fairly apportioned. We are also collaborating with the Department of Health’s new education branch on the development of educational resources for doctors, to address common knowledge gaps and compliance issues.

Practical tips to mitigate risks

In order to bill correctly, both individual providers and practices with administrative responsibility for Medicare billings, should ensure all documents related to claims for Medicare benefits are not false or misleading. Medical records should:

  • have separate entries for each attendance by the patient for a service and the date the service was provided or initiated
  • include adequate clinical information to explain the type of service provided or initiated at each attendance.
  • be sufficiently comprehensible that another doctor could rely on it for ongoing care
  • be written at the time the service was provided or as soon as practicable afterwards.

More information

If your practice receives an audit letter, please contact us at nca@avant.org.au or on 1800 128 268 for information or advice.

The Department of Health has released a factsheet, which includes responses to frequently asked questions.

Read our article ‘Reforms to Medicare compliance – firmer but fairer?

and complete our e-Learning course: Dial M for Medicare: Getting it right to manage your risks

Share your view

We welcome your feedback on this article.

< BACK TO LATEST NEWS