Two years after an independent review discounted claims that GPs were overbilling Medicare to the tune of $8 billion, the Health Services Union (HSU) has regurgitated the fraud claims.

This time, HSU, which represents workers from across the health and community services sectors, has published a report claiming that somewhere between $1.5 to $10 billion is lost to Medicare fraud and non-compliance each year.

HSU said its analysis of PSR case outcomes and case notes exposes major flaws in Medicare billing, including “upcoding” where medical practitioners inflate consultation times, as well as charging for services never provided, citing the recently discontinued GP Management Plans and Team Care Arrangements as “especially prone to misuse.”

Groundhog Day?

The HSU report feels a bit like Groundhog Day.

In 2023, an independent review commissioned by the federal government found no evidence to support allegations of $8 billion of fraud, which were attributed to Dr Margaret Faux and circulated widely in the media.

Instead, the review led by health economist Dr Pradeep Philip estimated that non-compliance costs Medicare $1.5-3 billion, mostly due to accidental non-compliance errors, rather than pre-meditated fraud.

Meanwhile University of Sydney researchers found that GPs underbill nearly 12% of consultations—compared with overcharging just 1.6%. Moreover, 85% of GPs who had overcharged at least once had also undercharged at other times, suggesting that errors, rather than deliberate fraud, were the more likely culprit.

Getting personal?

The HSU report takes direct aim at the AMA, describing their response to fraud allegations as “characterised by deflection, weak evidence, and resistance to oversight, putting financial interests and control ahead of meaningful systemic reform,” and “the same tired arguments it has relied on for decades.”

The RACGP is not spared either, with the union disparaging the idea that complexity is at play and that administrative tasks are a burden.

“A recent Royal Australian College of General Practitioners (RACGP) survey found ‘administrative burden’ to be a leading complaint and frustration of General Practice Specialists (GPs) – we argue that’s just part of the profession,” the HSU report scoffed.

Both peak bodies have hit back hard at HSU.

The College suggested HSU had repeated the debunked overbilling claims “to support their pay negotiations with the New South Wales Government.”

“These allegations have already been proven false,” RACGP president Dr Michael Wright said.

“GPs work under a tremendously complex Medicare system which features over 6,000 individual items, on top of all of our other responsibilities, and we do our best every day for patients,” Dr Wright said.

“Dr Phillip’s independent, comprehensive investigation found that the vast majority of Australia’s GPs are trying to do the right thing. Not only that, many GPs are underbilling out of fear of compliance, with our 2022 Health of the Nation report finding almost half of doctors either avoided providing some services or claiming patient rebates out of fear of Medicare compliance.”

AMA president Dr Danielle McMullen also said the claims had long been debunked.

“It is disappointing to see the HSU attempting to tarnish hardworking doctors in a flimsy report that contains baseless claim after baseless claim,” Dr McMullen said.

“We strongly encourage the HSU to check their sources and invest more effort into looking after the interests of their members, rather than mounting unjustified attacks on hard working medical professionals who are focused on delivering the best possible care for their patients.”

Specialist privilege?

The HSU report does point out that GPs are disproportionately referred to the PSR for investigation, accounting for 59.7% of MBS repayments from PSR investigations.

This is despite the fact that non-GP attendances account for nearly 70% of all MBS claims, “yet do not face the same level of scrutiny,” as HSU puts it.

“This discrepancy suggests that the PSR either assumes non-GP billers are less likely to engage in fraudulent or non-compliant billing, or, as our internal analysis confirms, it simply does not investigate them adequately.”