The Medicare induction program for new employees is not always running smoothly

Bureaucracy

“Look at this one: in 60% of the cases he co-claims a care plan and an attendance MBS item number!”

“Dodgy! How many careplans does he do?”

“About three a year. But still, he co-claims more than 50%! Tanya told us to get rid of these double-dippers.”

“Three care plans a year… That doesn’t seem like a lot. Shouldn’t we leave him alone?”

“Rules are here for a reason. These GPs earn enough as it is. Tanya said they receive $300,000 a year from Medicare.”

“I remember that… But didn’t the doctors say that this is not just personal income? I thought they use it to pay receptionist, nurses, and rent?”

“Maybe Tanya was wrong, but it’s still a lot of money. We can’t have them double dipping, that’s just not on. Look, here’s a GP who claims a lot of long consultations – over 50% of her total billings!”

“I read in the induction program that female GPs get a lot of ‘tears and smears’ and are claiming more long item numbers for that reason. They’re often worse off because two long item numbers per hour generate less income than four shorter ones. Doesn’t she actually save Medicare money?”

“Mike, listen to me, it’s not our job to make judgements. Here in the office the rule is simple: If you’re outside the norm you’re flagged and audited. Look at this GP: he has claimed heaps of mental health care plans, he’s way over the national average! I’ll have to let the guys from Professional Services Review know…”

“What if he specialises in mental health?”

“Mike! Our colleagues from the PCEHR are working on data mining, criminal content management and e-audits. That’s the future, man! We’re just here to look at the numbers, not at what the doctors are actually doing.”

“But these GPs are not rorting the system or double dipping. Aren’t they just offering a great service by doing a care plan and a consultation on the same day? Saves people having to take time off work twice.”

“As Tanya said: the government does not intend to inconvenience patients or to make it more difficult for GPs to use the general attendance items. Our main target is the 5.5% of GPs who co-claim more than 50% of the time, that’s all.”

“This is not why I applied for this job. I thought we were here to improve health care and…”

“Our approach will have no or only a small impact on the majority of GPs as 60% of doctors completing care plans do not co-claim or they co-claim less than 10% of the time.”

“You’re not listening, I said I wanted to make a difference and…”

“We process more than 500 million transactions and pay nearly $30 billion in benefits to pharmacists, doctors and the public every year. Someone’s got to keep them in line.”

“But.”

“…Medicare Australia has a proud history of high stakeholder satisfaction, such as over 90% public satisfaction! Over 21 million people are enrolled in Medicare!”

“What’s that got to do with it!?”

“Nicola always said it’s our job to make sure money is spent according to the rules!”

“Right. Like Nicola said, you’re all bastards! I quit!”

“Ah, 95.2% of Medicare employees quit during or after their induction program. Just be aware that you cannot claim sick leave and workers compensation as that would be regarded as double dipping.”

2 thoughts on “The Medicare induction program for new employees is not always running smoothly

  1. Always amazes me how the rorting of Medicare by the States seems to be ignored – despite probably adding up to millions of dollars

    The States are charged with providing public hospital services, including outpatient services. The Australian Healthcare Agreement is very clear that ‘patients are not to be charged’ fro these services.

    Yet many hospital OPDs now refuse to see outpatient referrals UNLESS there is a named referral – in order that they can bill medicare (bulkbill, natch) and so claim the medicare rebate

    In some cases patient referrals are being declined or preference given to those who meet billing criteria – not clinical need.

    Thus the States are able to reclaim costs by having their salaried doctors bulk-billing medicare. It’s a blatant cost shift from State to feds – yet Medicare seems to ignore this and go after the soft targets…

    Liked by 1 person

I'd love to hear from you! Please leave a comment:

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s