AMA Council of General Practice Chair provides information on compliance audits

22 Nov 2018

AMA Council of General Practice Chair, Dr Richard Kidd, outlines important information for GPs regarding Department of Health compliance audits in the latest issue of Australian Medicine. AMA’s legal counsel was consulted for the article.

The Department of Health regularly conducts compliance audits of practitioners to ensure that the amounts claimed under the Medicare Benefits Schedule (MBS) are correct.

Dr Kidd’s article outlines the general approach taken by the department, the courses of action available to recipients GPs or practice managers who receive letters, privacy concerns, and general advice.

One of the key points raised in the article is the need for practitioners to be mindful of protecting patient privacy when voluntarily providing documentation to support their claims. Australian Privacy Principle 6 prohibits practitioners from disclosing their patient’s records unless an exception applies. A key exception is where disclosure is ‘required or authorised by law’ (APP 6.2). When this is the case, the AMA recommends that practitioners exercise their statutory right to only provide documentation containing ‘clinical details relating to an individual’ to a departmental medical adviser.

The AMA also recommends that practitioners consult with their medical defence organisation before responding or submitting any documentation to the Department to ensure they are aware and understand the financial and legal consequences. For example, some practitioners may choose to voluntarily acknowledge an overpayment to avoid the administrative costs of locating records to prove their claims were legitimate. This will impact associated incentive payments claimed in conjunction with the payments for services.

More information is available in the article.