The Private Practice Summer 2013/14 Page 31

The Private Practice

Summer 2013/14

"This, however, is merely a function

of the lack of clarity of the language
of the Act. No entirely satisfactory
interpretation of the Act is as it seems to
me, available."

And in dissenting from the Chief

Justice, he went on to say:

"I do not accept that the legislature

intended to place doctors in the position
where a not unreasonable interpretation
of the Act leads them to make a claim
which ex post facto a judge (or, for that
matter, a jury) will find to be wrong
and render them liable to criminal
prosecution."

Dr Sood was found guilty by a

jury of 96 counts of Medicare fraud in
circumstances where she bulk billed
and also charged an additional fee.
She maintained from the outset that
she did not know that what she was
doing was wrong, and ample evidence
was provided in support of this view.
Applying the reasoning of Adams J, Dr
Sood had made a `not unreasonable'
interpretation of the MBS, yet it landed
her in a criminal court facing a jail term.

Clearly, medical claiming can be

very serious stuff. Medicare is a tax-
payer funded scheme, the integrity
of which is the responsibility of the

Federal Government. So it's not
something any clinician wants to get
wrong. But how do you get it right?
In the absence of a national curriculum
on the subject, where can anyone go
for reliable information and support?

AROUND IN CIRCLES

Perhaps not surprisingly, Medicare
has always maintained that
ample information and support
is available to providers. However
there is evidence to suggest that
some clinicians disagree. Consider
this submission to the 2011
Senate Committee enquiry, which
investigated the operations of the
Medicare Professional Standards
Review committee:

"I was concerned to get the Medicare

numbers right for this clinic. They are not
straightforward. So I sent quite a lot of
information to Medicare asking for help.
I said: `Are these odd numbers right?
Is what I am going to charge right?' It
took months to get a reply. I got a reply
saying: `We cannot give you an answer,
Dr Masters. We suggest you contact the
AMA and the college of GPs.' I contacted
the AMA and the college of GPs...and
they said: `We are not here to interpret

the Medicare schedule. That should be
done by Medicare.' Medicare will not do
it. The PSR will not do it. The AMA will
not do it. The college of GPs will not do it.
And we get fined."

The collective buck-passing

eloquently expressed by Dr Masters
leaves providers with little option
other than to try and work it out
themselves or ask their peers, who
themselves are in no greater position
to know the answers. It serves
only to perpetuate MBS myths,
misunderstandings and, ultimately,
claiming errors.

QUESTIONS & THE ISSUES
THEY RAISED

Let's have a look at provider numbers,
where it really shouldn't be too hard
to work out which one to use when.
After all, provider numbers are a
cornerstone of the Medicare scheme
and a pre-requisite for enabling
patients to be reimbursed for medical
expenses they have incurred.

If the practitioner doesn't have a

Medicare provider number, patients
can't claim Medicare benefits simple.
Yet I am asked questions such as the
following almost daily.

MEDICAL BILLING

NUMB R C R U N C H