Home Health Telehealth billed patients in bulk at the same time as collecting fees,...

Telehealth billed patients in bulk at the same time as collecting fees, documents show

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Medicare’s systemic denial artificially inflates official statistics showing that nearly nine out of 10 patients receive wholesale bills from their doctors and pay no out-of-pocket costs.

A joint Medicare investigation by ABC 7.30, The Sydney Morning Herald and The Age has uncovered errors and wrongdoing by health professionals that are skewing national figures.

Some experts are convinced that the mass bill is much lower: about four to six for every 10 visits to the doctor.

Leaked documents show that one of the nation’s largest telemedicine companies, Phenix Health, billed some patients at the same time as charging them, which is illegal under the Health Insurance Portability Act.

A legal method for doctors who do not bulk bill is to charge the patient, who then receives a rebate from Medicare.

Dr. Margaret Fox, a lawyer with a PhD in Medicare claims and compliance, said carriers who charge fees and then bill in bulk for the same service have skewed Medicare statistics. She says about four out of 10 patients – not nine out of 10 – don’t pay out of pocket to see a GP.

Dr. Margaret Fo said Synapse Medical Services recently dropped Phenix as a client.(Four corners)

In August, The Australian cited figures released by the Primary Care Business Council, a lobbying group representing some of the country’s biggest GP operators, which estimated the mass Medicare payment rate was about 61 per cent, or 6 in 10 patients.

Questions about the accuracy of the data prompted a departmental review of Health Minister Mark Butler.

However, Dr Fo called on the government to make the review independent and more comprehensive. She estimated that up to $8 billion is lost to Medicare each year due to fraud and noncompliance, nearly 30 percent of Medicare’s current $28 billion in annual costs.

Awareness of potential illegality

The revelations come as GPs are lobbying the government to increase bulk billing discounts, arguing that bulk billing is in crisis and they can no longer afford to offer it unless the Medicare rebate is increased.

Dr. Fox, whose Synapse Medical Services business is paid by doctors, hospitals and corporate medical practices to process their Medicare bills, recently dropped Phenix as a client.

https://www.abc.net.au/news/2022-10-18/medicare-bulk-billing-statistics-aritificially-inflated/101544098

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