AMA Submission on Shared Debt Recovery

6 Feb 2019

The AMA supports the introduction of a fairer approach to the recovery of Medicare debts incurred as result of incorrect billing. While medical practitioners are primarily responsible and accountable for their billings, the Shared Debt Recovery Scheme recognises that there are circumstances where an employing or contracting organisation may have undue influence or control over a practitioner's claims against Medicare and should be responsible for a share of any resulting debt.

The AMA's submission highlights the types of employment or contractural arrangements that should be covered under the scheme, including any contractual arrangement that takes control of a practitioner’s billing, includes a fixed period of service, any incentive tied to type or volume of services, includes required billing targets, or KPIs which require a defined clinical activity target and for which there are associated penalties for noncompliance, could be considered coercive and thus appropriate for consideration of a shared debt arrangement. The AMA notes that where there is evidence of a coercive arrangement or recidivist behaviour on the part of an entity, this should be a factor in considering the apportioning of a higher and significant percentage of debt under the shared debt recovery scheme.

In addition, the AMA submission provides some guidance on what types of evidence could be used in substantiating consideration of a shared debt and on the circumstances that could influence any adjustment of the default 65%/35% apportionment of shared debt.