Diabetes registration system ... government bribery for capitation, now its even more obvious. GP's complain about the iniquity of the system and what's the goverment response? .. offer more money !! ... "The Government had already promised practices would be paid $1200 per year for each enrolled patient, $950 of which would cover day-to-day GP care, and $250 to cover the costs of allied health care. But the additional measures will hand practices a $1500 upfront payment for signing up to the program plus an additional annual payment of $100 per registered patient."
Disgusting ... heaven forbid if you are a complicated diabetic patient, no one is going to sign you up "voluntarily" ... and if you are a non-complicated diabetic, then shop around for the "highest bidder", you are worth a fortune to the corporates !
Monday, April 12, 2010
Wednesday, March 31, 2010
Double dipping not allowed ? ...
Finally someone has the balls to deal with this issue .. well at least put a public appearance in of dealing with it. It aint going to be as easy as simply saying "you can't do it".
Saturday, March 27, 2010
Hypothetical
The local bakery closes down. They say its cheaper to bake the bread the other side of the mountain and ship it to the local store. It looks cheaper because the bakery does not have to pay for the shipping costs, but the reality is that the over all cost of the provision of bread to the local community becomes more expensive. Just no one knows because the only politically sensitive cost is the production cost, not the shipping cost. At least the locals dont have to walk over the mountain to get their bread ... yet.
I am not talking about bread.
I am not talking about bread.
Thursday, March 18, 2010
Screw Medicare ... screw me screw you
The Australian Medicare system was introduced in 1975, initially as "Medibank" and renamed as "Medicare" in 1984.
Since my graduation from medical school in 1982 I have been observer of (and sometimes complicit in) the manipulation, distortion and outright abuse of the Medicare system. The elements of human greed (no, doctors are not immune from this), the stupidity and shortsightedness of politics and the entitlement syndrome of the Australian psyche are all mixed to pollute what otherwise was a well intentioned but destined to fail system.
My first exposure to the iniquity of the system was when I received a cheque from Medicare in my first year of full time practice as payment for an operation I did not do and could not have done (as I neither had the expertise nor was in Australia at the time I allegedly performed the operation). I reported this to both the AMA (my medical "union") and Medicare. There was was no followup or feedback from this incident but there were rumors floating around at the time that some inhouse within Medicare were putting in false claims and diverting the payment cheques to themselves.
The flourishing of corporate bulk billing services from the early 1980's onwards, courtesy of highly creative entrepreneurs such as Geoffrey Edelsten and Ian McGoldrick (both who I have met personally, and I have worked in and observed their clinic machinations) and those emulating their service model led to quite extensive abuse of the Medicare system, if not illegally, certainly at a moral and ethical level. There certainly were illegal practices in some places but these were not widespread - the big corporates even at that early stage had (very) well paid legal advisors to tread the line but not overtly cross it.
Patients under workers compensation (specifically excluded from Medicare) required by clinic staff to sign a blank Medicare forms to be put in the patient file incase an employer/worker's comp. insurer refuses to pay the account. "Just in case" ... yes Medicare benefits are payable whilst liability is under dispute but not signing a blank cheque medicare claim form in addition to billing a private account. I worked for that clinic for less than a week.
A pile of blank, signed Medicare forms left in a patient's file. Obviously an elderly patient who was obtaining home visit care from the solo GP concerned but seriously a pile of blank, signed forms !! Another clinic I left shortly thereafter.
The system encouraged high turnover care .. bringing life to the term "6 minute medicine". The medicare rebate was (at that time) the same for 6 minutes of time as it was for 24 minutes of time. The answer is quite clear ... see 1 patient for 1 fee in 24 minutes or see 4 patients for 4 fees. It took a very long time for the Health Insurance Commission / Medicare auditors to identify this as inappropriate behaviour, but it was only the extreme ends over time that were ever dealt with in high profile individual cases.
The profitable procedural items were identified and used by certain less than savoury practitioners, in house referrals for radiology and pathology services, in house referrals to specialists who agree to bulk bill for their own 10 minute consultations, and not infrequently seen on the day of the GP consultation for a factitious reason as a "second opinion".
Then came the Medicare "safety net". Private hospital emergency departments who charged a small doctor's fee and a large (very large) "facility" fee literally overnight changed their billing practices so that the whole fee was a "doctor's fee" so that only a few visits to a private ED would trigger the safety net and make future visits "affordable" ... ie. scamming medicare to pay almost the whole, inflated fee. Private obstetricians also pre-safety net had a separate private "delivery fee", that was separate to and above their normal medical fees. Guess what happened to obstetric fees post-safety net?
And it was not just the private system rorting Medicare ... public hospitals closed their outpatient services some time back. Oh .. but surprise, surprise the same facilities, the same resources the same doctors continued to practice in private consulting clinics in the same fashion as the outpatient clinics except patients were refused attention without a "GP referral" so Medicare could be billed (bulk-billed so the patients didn't care) redirecting state health financial responsibilities onto the commonwealth !! Check this out here although bless "The Age", their dear hearts, they are only many years late in reporting this!! Other cost shifting occurs .. GPs doing public hospital pre-anaesthetic checks with consultation and investigations billed to medicare. Public hospital obstetric care ? ... women are lied to being told they can't get into their first consultation until, so it happens, after its too late for when most of the important antenatal screening tests should be done, so the women are given a list of tests their GP "needs to order", again billed to medicare instead of coming out of hospital funding. Oh by the way, the hospital is happy to do the ultrasound and blood tests with a "private" referral from the GP, billed to medicare of course, but NOT include in part of their own service obligations.
Now the way for GPs to scam Medicare is "value adding" consultations .. no longer will the corporates encourage GPs in their practices see 10+ patients per hour, its now on average 4.3 patients per hour, but many are "value added". But its not just the corporates, its community health centres, private GPs and others with access to the care planning medicare item numbers.
Charge deep laceration repairs for the superficial repairs. Charge removal of a deep, imbedded foreign body when it was a superficial splinter. Charge a removal of a corneal foreign body for the removal of a sub-tarsal foreign body. Charge standard consultations for 3 minutes of your time. If you do this carefully no one will find out .. because if everyone does it, it is never going to be flagged by the software algorithms.
And with bulk billing the patient will never know, because they were never directly billed for the amount you charged ... they just sign a medicare form. That's if you ever have the patient sign the form ... just today I saw my own GP who sadly has moved into a much larger facility where his practice is now "managed" and the receptionist was quite clear I did not need to sign a medicare form for being bulk billed - I asked, because I know I am supposed to, and she assured me that I did not need to sign a form. I will have to tell my GP that the practice management is allowing this to happen, it certainly will not be being done with his knowledge or approval (yes there are honest GPs out there ... in fact most are, but too many are not). I have no idea how much I was bulk-billed for today !
Medicare rorting does make the news .. but in a small way. You might be interested to read this recent media report.
Nicola .. do you have the political will to attempt to change this system ? I applaud recently publicised individual cases of medicare abuse, but this is not the rare individual, it is wide spread and a pervasive disease in the system. Good luck and godspeed.
So why do I say "screw medicare ... screw me screw you" ? ... because my taxes your taxes fund (at least in part) medicare. Rip off medicare, you and I are being ripped off and in the long term (for short term greed) the community suffers, badly. Feel free to report it if you see it.
( conceived years ago, document draft started February 2010, published after much consideration March 2010 )
Since my graduation from medical school in 1982 I have been observer of (and sometimes complicit in) the manipulation, distortion and outright abuse of the Medicare system. The elements of human greed (no, doctors are not immune from this), the stupidity and shortsightedness of politics and the entitlement syndrome of the Australian psyche are all mixed to pollute what otherwise was a well intentioned but destined to fail system.
My first exposure to the iniquity of the system was when I received a cheque from Medicare in my first year of full time practice as payment for an operation I did not do and could not have done (as I neither had the expertise nor was in Australia at the time I allegedly performed the operation). I reported this to both the AMA (my medical "union") and Medicare. There was was no followup or feedback from this incident but there were rumors floating around at the time that some inhouse within Medicare were putting in false claims and diverting the payment cheques to themselves.
The flourishing of corporate bulk billing services from the early 1980's onwards, courtesy of highly creative entrepreneurs such as Geoffrey Edelsten and Ian McGoldrick (both who I have met personally, and I have worked in and observed their clinic machinations) and those emulating their service model led to quite extensive abuse of the Medicare system, if not illegally, certainly at a moral and ethical level. There certainly were illegal practices in some places but these were not widespread - the big corporates even at that early stage had (very) well paid legal advisors to tread the line but not overtly cross it.
Patients under workers compensation (specifically excluded from Medicare) required by clinic staff to sign a blank Medicare forms to be put in the patient file incase an employer/worker's comp. insurer refuses to pay the account. "Just in case" ... yes Medicare benefits are payable whilst liability is under dispute but not signing a blank cheque medicare claim form in addition to billing a private account. I worked for that clinic for less than a week.
A pile of blank, signed Medicare forms left in a patient's file. Obviously an elderly patient who was obtaining home visit care from the solo GP concerned but seriously a pile of blank, signed forms !! Another clinic I left shortly thereafter.
The system encouraged high turnover care .. bringing life to the term "6 minute medicine". The medicare rebate was (at that time) the same for 6 minutes of time as it was for 24 minutes of time. The answer is quite clear ... see 1 patient for 1 fee in 24 minutes or see 4 patients for 4 fees. It took a very long time for the Health Insurance Commission / Medicare auditors to identify this as inappropriate behaviour, but it was only the extreme ends over time that were ever dealt with in high profile individual cases.
The profitable procedural items were identified and used by certain less than savoury practitioners, in house referrals for radiology and pathology services, in house referrals to specialists who agree to bulk bill for their own 10 minute consultations, and not infrequently seen on the day of the GP consultation for a factitious reason as a "second opinion".
Then came the Medicare "safety net". Private hospital emergency departments who charged a small doctor's fee and a large (very large) "facility" fee literally overnight changed their billing practices so that the whole fee was a "doctor's fee" so that only a few visits to a private ED would trigger the safety net and make future visits "affordable" ... ie. scamming medicare to pay almost the whole, inflated fee. Private obstetricians also pre-safety net had a separate private "delivery fee", that was separate to and above their normal medical fees. Guess what happened to obstetric fees post-safety net?
And it was not just the private system rorting Medicare ... public hospitals closed their outpatient services some time back. Oh .. but surprise, surprise the same facilities, the same resources the same doctors continued to practice in private consulting clinics in the same fashion as the outpatient clinics except patients were refused attention without a "GP referral" so Medicare could be billed (bulk-billed so the patients didn't care) redirecting state health financial responsibilities onto the commonwealth !! Check this out here although bless "The Age", their dear hearts, they are only many years late in reporting this!! Other cost shifting occurs .. GPs doing public hospital pre-anaesthetic checks with consultation and investigations billed to medicare. Public hospital obstetric care ? ... women are lied to being told they can't get into their first consultation until, so it happens, after its too late for when most of the important antenatal screening tests should be done, so the women are given a list of tests their GP "needs to order", again billed to medicare instead of coming out of hospital funding. Oh by the way, the hospital is happy to do the ultrasound and blood tests with a "private" referral from the GP, billed to medicare of course, but NOT include in part of their own service obligations.
Now the way for GPs to scam Medicare is "value adding" consultations .. no longer will the corporates encourage GPs in their practices see 10+ patients per hour, its now on average 4.3 patients per hour, but many are "value added". But its not just the corporates, its community health centres, private GPs and others with access to the care planning medicare item numbers.
- Mental health care plans for patients not needing psychologists referrals (or to see a sex therapist who just happens to have a medicare provider number while there is no associated qualifying mental health issue), mental health referrals for drug and alcohol service clients who can't be provided adequate resources due to appalling funding arrangements for D&A services but they have found a private psychologist with an interest/expertise in D&A issues prepared to bulk-bill medicare.
- Care plans for patients requesting a referral to a physiotherapist, podiatrist or other allied health care worker but the patient does not qualify under the detailed guidelines or if they do, none of the procedural work to create a genuine care plan is put in place - medical software can create a template in 30 seconds !!
- Referrals to orthodontists for cosmetic work because the patient has an "anxiety disorder" that the orthodontic work can cure !
Charge deep laceration repairs for the superficial repairs. Charge removal of a deep, imbedded foreign body when it was a superficial splinter. Charge a removal of a corneal foreign body for the removal of a sub-tarsal foreign body. Charge standard consultations for 3 minutes of your time. If you do this carefully no one will find out .. because if everyone does it, it is never going to be flagged by the software algorithms.
And with bulk billing the patient will never know, because they were never directly billed for the amount you charged ... they just sign a medicare form. That's if you ever have the patient sign the form ... just today I saw my own GP who sadly has moved into a much larger facility where his practice is now "managed" and the receptionist was quite clear I did not need to sign a medicare form for being bulk billed - I asked, because I know I am supposed to, and she assured me that I did not need to sign a form. I will have to tell my GP that the practice management is allowing this to happen, it certainly will not be being done with his knowledge or approval (yes there are honest GPs out there ... in fact most are, but too many are not). I have no idea how much I was bulk-billed for today !
Medicare rorting does make the news .. but in a small way. You might be interested to read this recent media report.
Nicola .. do you have the political will to attempt to change this system ? I applaud recently publicised individual cases of medicare abuse, but this is not the rare individual, it is wide spread and a pervasive disease in the system. Good luck and godspeed.
So why do I say "screw medicare ... screw me screw you" ? ... because my taxes your taxes fund (at least in part) medicare. Rip off medicare, you and I are being ripped off and in the long term (for short term greed) the community suffers, badly. Feel free to report it if you see it.
( conceived years ago, document draft started February 2010, published after much consideration March 2010 )
Monday, February 22, 2010
Gladstone Superclinic
Due to the unprecedented success of the NT Superclinic, Gladstone gets its own ... $5 million dollars to set it up as a sop for the local politics. Any guesses on who is going to staff it, doctorwise ?
Oh by the way ... take a peek at the side article on how there are no shortages of doctors in Gladstone. Coralee, if you are watching ... you might want to be better informed before making such sweeping statements as "Gladstone Hospital has no shortage of doctors". Looks bad if you get it wrong, very bad.
Thursday, January 28, 2010
Teaser ...
.. upcoming soon ..
"How to rip off Medicare"
I have pondered for some time speaking of my experiences over the decades of how the Australian Medicare system has been badly abused by both the medical consumer and the medical service provider.
Now is the time. Over my current locum at Gladstone I will be drafting an article for your pleasure and my catharsis ... watch this space !
"How to rip off Medicare"
I have pondered for some time speaking of my experiences over the decades of how the Australian Medicare system has been badly abused by both the medical consumer and the medical service provider.
Now is the time. Over my current locum at Gladstone I will be drafting an article for your pleasure and my catharsis ... watch this space !
Wednesday, January 6, 2010
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