The Department of Health and Aged Care can track whether you’re in or out of the country.
Medicare will be contacting roughly 5800 GPs that it suspects of having billed to Medicare while not physically in the country, The Medical Republic can confirm.
The compliance letters are set to be mailed out in mid-May and will encourage recipients to review their billing practices and return any incorrectly received Medicare benefits.
The nudge letter campaign is premised on the fact that section 10 of the Health Insurance Act 1973 expressly states that, in order to be eligible for a Medicare rebate, the medical service has to have occurred in Australia.
Ergo, telehealth services rendered while either the practitioner or patient was not physically in Australia must be entirely privately billed, with no Medicare rebate attached.
While the law officially states that both doctors and patient need to be in Australia to claim a Medicare rebate, this particular compliance campaign is focused only on doctors who have practiced while travelling.
A requirement for Medicare services to be rendered in Australia has existed since the first iteration of the Health Insurance Act, when telehealth was but a twinkle in Medicare’s eye.
Related
Part VIIIA of the National Health Act authorises the Chief Executive of Medicare to authorise a Commonwealth entity like DoHAC to match its data on claims and identities with that of other Commonwealth entities for the purpose of identifying and recovering incorrect Medicare payments.
This rule allows DoHAC to match the dates of MBS claims made by a health provider with the Home Affairs passenger records of patients and health providers.
DoHAC can also use this power to match MBS and PBS data to identify whether corresponding medical consultations and pathology services meet pharmaceutical benefit requirements, or MBS and DVA data to identify where a provider may be illegally claiming both Medicare and DVA benefits.
According to DoHAC’s public register, the department has been matching Home Affairs passenger movement records (passenger name, date of birth, gender and date of arrival and/or departure) to Medicare claims records (provider or patient name, date of birth, gender and date of service) since August 2021.
It is set to continue this data matching exercise until August 2026.
DoHAC has already been in contact with GPs this year; in March, it sent letters to doctors in danger of reaching the 80/20 prescribed pattern of service threshold by rendering 80 or more services per day on 20 days in one year.
