Key points

• GPs are sharing tactics for maximising Medicare billing on doctors-only Facebook groups.
• The tactics include Medicare billing “cheat sheets”, tips on avoiding audits and raising gap fees without patients noticing.
• The RACGP, the professional body for GPs, says it doesn’t support maximising Medicare billing for the sake of boosting revenue.

GPs are sharing tactics for maximising Medicare billing on doctors-only Facebook groups, including sharing a list of so-called “little frauds” and techniques for “packing and stacking” their billing so multiple services are billed from single patient attendances.

Medicare billing “cheat sheets”, tips on avoiding audits and raising gap fees without patients noticing feature in online groups such as the private Business for Doctors Facebook page, which has 32,000 members and a “doctors-only” membership policy.

Some GPs have been talking about ways to maximise Medicare charges.Credit:

It comes after revelations in this masthead that flaws in the Medicare system have led to up to $8 billion, or 30 per cent of Medicare’s budget, being lost through errors, fraud and overservicing.

One doctor jokingly posted a list of so-called “little frauds” on the private GPs Down Under Facebook page, itemising non-compliant Medicare billing, and suggested some GPs would be familiar with the techniques.

It included billing Medicare for talking with patients’ relatives, billing for taking an unnecessary blood pressure test when a patient is really applying for a commercial driver’s licence, and billing for services that were not provided.

“If you bill Medicare for the sole purpose of financial gain it is illegal,” said Dr Margaret Faux, a researcher and Medicare expert whose law firm provides free information on correct Medicare billing.

“There may be a perception that these things exist in a grey area, but that is often not the case. Billing unnecessary services is a type of fraud.”

Faux’s research into Medicare costs found that large-scale non-compliance with billing rules potentially costs taxpayers billions.

A GP who runs a company that teaches doctors to boost their Medicare billing posted pictures of her billing records on the Business for Doctors page showing she had billed $4466 in a day.

She explains the benefit of her training saying, “Historically, you attend and the following day your billings increase by 25 per cent. In three months your billings can double once you have your templates and documentation shortcuts created. If you are billing less than $1000 per day you can TRIPLE your billings.”

Many GPs posted that they were impressed with the results and wanted to know more about the “pack and stack” method for squeezing the most out of Medicare.

The website for the doctor education business states that it meets all legal and ethical standards, and that its aim is to improve Medicare compliance and maximise patient rebates and reduce their out-of-pocket expenses by ensuring doctors understand the correct way to claim under the complex system.

The GP said that she had been audited six times and passed, and 19 other doctors who had undertaken her training courses had also passed audits.

Packing and stacking involves maximising the number of items Medicare is billed for during each patient attendance, leading to more revenue for the doctor, and encouraging patients to return frequently for more check-ups, or to receive test results or follow-up care.

Some doctors posting in the Facebook groups argue that practices such as the “pack and stack” method are a legitimate way to boost both revenue and patient care, but others voiced qualms.

“I hate the pack and stack and I think it’s unethical,” one doctor wrote in a discussion on the private Australian Society of General Practice Facebook group.

“I say to fellow GPs they should not bill anything to Medicare that they wouldn’t be charging if that patient wasn’t there. That is really the definition of maximising rebates. Otherwise, it’s maximising revenue and possibly milking the system.”

The RACGP, the professional body for GPs, said it didn’t support maximising Medicare billing for the sake of boosting revenue, but multiple billings were often the best way to reflect the care given to a patient.

“The RACGP supports ethical and responsible billing practices,” the group’s vice president Dr Bruce Willett said in a statement.

“We do not endorse billing multiple MBS [Medicare Benefits Scheme] items during a single attendance purely for the purpose of maximising income. However, in many cases, billing multiple MBS items is entirely appropriate for patients with numerous healthcare issues.”

Many doctors were under-billing or not claiming rebates because of the complexity of the Medicare claims process, he said.

The group said it is lobbying for a simpler Medicare billing structure to help address doctor’s concerns.

Strategies on boosting patient fees were also a topic of discussion on the doctors-only Facebook groups. One wrote: “my tip is to set fees that are not ’round’ – that way patients will often not notice when the price goes up (eg, we went from $51 out of pocket to $56).”

When an investigation into Medicare waste was published in this masthead on October 17, the Facebook groups lit up with fury. There were suggestions of a class action on behalf of doctors, a social media campaign to defend doctors’ integrity and calls for the Australian Medical Association to do more to defend the profession.

There were many disparaging personal comments about Faux, who was quoted in the media reports.

“She is a nurse with a PhD,” one doctor wrote. “So gets to call herself a doctor. It’s all about agendas and axes to grind.”

Others in the groups had a different view. “We are some of the most privileged members of the Australian community,” one doctor wrote. “Pretty sure we can expend our energy on something more productive than throwing the toys out of the cot because someone called us names.”

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