GA 2020/065
Answer
No.
Context
Doctor A asked what happens when the treating doctor goes overseas for a week of conference leave while the patient is midway through a course of treatment such as chemotherapy or radiotherapy. The patient cannot stop or delay the treatment, because it is required to be administered via incremental doses at set intervals. The doctor incorrectly thought that billing could continue from overseas under the supervision arrangements.
Relevant Legislative Provisions
Other Relevant Materials
1. Parliamentary Bills Digest – Health Legislation Amendment (Data-matching and Other Matters) Bill 2019.
2. Industry article regarding the passage of the Medicare data matching bill through parliament in 2019. Medicare data-matching bill passes Parliament. https://www.innovationaus.com/medicare-data-matching-bill-passes-parliament/
Case law
NA
Departmental Interpretation
mbsonline.gov.au (accessed 25 June 2020)
AN.0.6 Patient Eligibility
Medicare covers services provided only in Australia.
GN.12.31 Services rendered on behalf of medical practitioners
Supervision from outside of Australia is not acceptable.
Detailed Reasoning
Medicare benefits are only payable for services rendered IN Australia.
Section 10 of the Health Insurance Act 1973 provides:
“(1) Where, on or after 1 February 1984, medical expenses are incurred in respect of a professional service rendered in Australia to an eligible person, medicare benefit calculated in accordance with subsection (2) is payable, subject to and in accordance with this Act, in respect of that professional service.”
This provision has always been interpreted by the department as meaning both the patient and the provider must be in Australia at the same time. Some years ago an Australian radiology group fell foul of this requirement when they were claiming for services provided by radiologists who were reading the films of Australians via remote access from a U.K office of the radiology company overnight.
Further, supervising while overseas is not permitted as per the above quote from the MBS.
To tighten the government’s ability to audit this requirement, late in 2019 new data matching laws were successfully passed through parliament, which give the department power to match data across various agencies, one of which is Home Affairs. The stated objective of matching to this particular data set was as follows:
“Data matching with records held by the Department of Home Affairs that indicate whether a person is overseas will allow confirmation that both the healthcare provider and patient were in Australia at the time of their claimed services.”
So now Medicare can match immigration records to determine whether a doctor and/or patient were in Australia on the dates services were claimed.
The locum billing arrangements were designed to enable doctors to have periods of leave, including overseas travel, and have always been available. All medical specialists use locum cover, where the locum takes over the care of patients during the relevant period of leave, and bills for the services she/he provides using her/his provider number. In this way doctors support each other during periods of leave while ensuring continuity of care for their patients.
There is nothing inherently different about any particular specialty that would make locum arrangements inappropriate.
Examples and other relevant information
Remember always: the doctor who provides the service, bills the service. The locum must therefore bill under her/his name and provider number.
Knowingly billing for a service you did not personally provide is fraud.
You do not supervise a locum. The locum arrangements are designed such that the locum takes over the care of your patients and personally bills for for the services she/he provides.
Who this applies to
Everyone
When this applies
Always. Further, the new data-matching laws apply retrospectively in the sense that this has always been illegal, but now the Government has the ability to easily view immigration records to prove it has occurred.