OH 2020/0715
Answer
No.
Context
Doctor A was an oncologist who understood that when on leave with a locum covering, Doctor A could continue billing as usual, even though Doctor B was acting as a locum and was providing all services to Dr A’s patients. Doctor A would reimburse Dr B for the locum services under an agreement they had reached.
Relevant legislative provisions
Health Insurance (General Medical Services Table) Regulations (No.1) 2020
Other Relevant Materials
1. Professional Services Review, Panel Newsletter, October 2019
2. Recent commentary in Australian Doctor: “GP slammed by PSR for loaning out provider number.”
Case law
N/A
Departmental interpretation
“Professional Services Review Committee No. 1052:
On 6 September 2019, a final determination came into effect concerning Dr Mainul Hossain, a medical practitioner who practised in Morisset, New South Wales during the year under review. Dr Hossain allowed another practitioner to bill Medicare under his Medicare provider number for services they rendered.“
Detailed Reasoning
Provider numbers are a critically important component of the Medicare scheme, enabling the government to have visibility over service provision by eligible practitioners, track and monitor the distribution of public funds and preserve the overall integrity of the Medicare scheme.
The relevant law that says provider numbers must be included on medical bills is Section 19(6) of the Health Insurance Act. It is an indirect reference using the common legal jargon “prescribed particulars”. It is copied below:
“(6) A medicare benefit is not payable in respect of a professional service unless the person by or on behalf of whom the professional service was rendered, or an employee of that person, has recorded on the account, or on the receipt, for fees in respect of the service or, if an assignment has been made, or an agreement has been entered into, in accordance with section 20A, in relation to the medicare benefit in respect of the service, on the form of the assignment or agreement, as the case may be, such particulars as are prescribed in relation to professional services generally or in relation to a class of professional service in which that professional service is included.”
The linking law, that sets out the prescribed particulars, is found in Division 5, Regulation 51(2) of the Health Insurance Regulations 2018 which provides as follows (my underlining):
“51(2) Subject to subsection (3), prescribed particulars are:
(a) the name of the person who rendered the service and the address of the place of practice where the service was rendered; or
(b) if the service was rendered at a place of practice for which the person rendering the service has been allocated a provider number—the provider number; or
(c) if the service was not rendered at such a place of practice—the provider number allocated to the person for any place where the person practices;
and a statement that the professional service was provided by that person.”
The law is clear in that it provides that either the provider number or the name and address of the person ‘who rendered the service’ must be included on all accounts billed to Medicare, or in the circumstances described in sub reg c), an actual statement that the ‘service was provided by that person’.
Even when supervising under permitted supervisory arrangements, claims must be made in the name of the person supervising who must take full responsibility for the service supervised, evidence of which will be provided in the patient’s clinical record.
Do not ever share or loan provider numbers. Ever. It is a serious breach of the scheme’s requirements involving a complete misrepresentation to the government of who provided the service.
Remember always, Medicare is funded by taxpayers – it is public money – and the government has a constitutional responsibility to properly account for every dollar distributed. Misrepresenting who has provided a service is therefore, quite properly, a serious matter and if discovered, like Dr Hossain (above quote), the consequences are also serious.
Examples and other relevant information
N/A
Who this applies to
Everyone
When this applies
Always