Bulk-billing GPs accused of Medicare breach by also charging patients

Thousands of Australians are being asked to pay membership fees to general practitioner (GP) clinics to access bulk-billed medical care.

Almost 100 GP clinics have started charging the fees – according to medical data company Cleanbill – and experts say it’s a breach of Medicare rules.

Grattan Institute health program director Peter Breadon said the practice amounted to “double dipping”.

“Getting money from the government that is explicitly linked to not charging fees [while charging fees] I think is fairly dishonest and not allowed,” he said.

“It really flies in the face of the idea of bulk-billing.”

According to the Australian government’s Services Australia website, bulk-billing means patients don’t have to pay for a medical service from a health professional.

“They bill us instead and they accept the Medicare benefit as full payment for the service,” the website states.

Regional clinic charging patients to access bulk-billed care

One of the clinics charging ‘membership fees’ is Mildura-based medical chain Kure Medical, which operates three out of the 14 clinics in the region.

For a $220 fee, patients in Mildura can access 12 months of bulk-billed medical care at Kure, or for $330 a family can access 12 months of bulk-billed care.

The ABC has verified the Medicare claims history of two patients who each signed up for the $330 family package, showing the clinic bulk-billed Medicare in addition to charging membership fees.

For one patient, the clinic billed Medicare more than $400 for multiple consultations. For the second patient, the clinic billed Medicare $34.25.

On its practice information sheet, Kure Medical describes itself as a “mixed billing” practice with “annual private rates” which “cover patients for 12 months from date of payment”.

Royal Australian College of General Practitioners president Nicole Higgins said practices charging an annual administration or registration fee to guarantee a patient bulk-billed services were breaching Medicare rules.

The Medicare Benefits Schedule states: “If a practitioner bulk-bills for a service the practitioner undertakes to accept the relevant Medicare benefit as full payment for the service.”

“Additional charges for that service cannot be raised.”

Kure Medical did not respond to the ABC’s request for comment.

Bulk-billing deserts

Mildura pensioner Sue Watson has complex health issues requiring a GP appointment approximately once every three weeks.

She described Kure Medical as a “rip-off”.

“[Bulk-billing is] supposed to be free healthcare,” she said.

Ms Watson said she and her partner couldn’t afford the $330 up-front cost to access the bulk-billed service because they were on a pension and had limited savings.

“It totally negates the purpose of a bulk-billing clinic,” she said.

The federal government has hosed down the calls from within its own ranks.

Mr Breadon said the situation in Mildura, where there were few bulk-billed services available, was common in regional areas across Australia.

“In these places with fewer GPs, you’re much less likely to get bulk-billed care. And these are often the places where people are also more likely to be disadvantaged and more likely to be sicker,” he said.

“So it’s a really perverse outcome that a lot of the communities with more illness and more disadvantage often have less bulk-billing and less GP services to go around.”

Mr Breadon said clinics found to be “double dipping” should be required to repay any government rebates they had received and should be considered ineligible to receive further incentives.

In November last year, the federal government tripled the bulk-billing incentive payment it paid to doctors for patients and consultations that met certain conditions.

For bulk-billed patients who meet these conditions, Medicare pays a higher rebate than it does for a private patient.

Patients willing to pay

Kure Medical is the only GP clinic in Mildura that offers bulk-billed care to patients who don’t have a concession card.

So for many residents, it’s their most affordable GP option, despite the additional membership fee.

TAFE student Nicki Jose, 52, said paying the annual fee worked out cheaper than paying for private consultations each time she needed to access a doctor.

“It already has paid for itself,” Ms Jones said.

“I think it’s fantastic knowing I can go there and not be worried about finding the money for the doctors and they let you pay it off in a couple of weeks.”

Practice increasingly common

Cleanbill published data in April showing clinics collecting government rebates while also charging patients membership fees were becoming increasingly common.

The report found there were at least 98 clinics nationwide charging subscription fees or memberships for bulk-billed services despite rules against the practice.

Medical billing legal expert Margaret Faux said the practice was “rampant” but difficult for the government to detect.

“[The extra fee] doesn’t go to the government, so they don’t see it. If it’s tapped on a separate EFTPOS machine, they have no visibility over it,” she said.

Clinics captured in the Cleanbill data charged on average $77.94 per membership, with the highest average in Tasmania at $167, and the lowest in South Australia at $60.

Dr Faux said clinics charging membership fees could be distorting government data on bulk-billing.

“All their bulk-billing is dropping into the bulk-billing statistics that the government periodically trumpets and says, you know, 80 per cent, or whatever it is now, of GP services are bulk-billed, meaning patients did not pay any money,” she said.  

“And that is not true. They did. It was just called something else.”

Government ‘taking allegations seriously’

According to the federal government, 79 per cent of GP visits were bulk-billed in May.

The ABC asked the federal health department if it had audited bulk-billing clinics to find out if they were also charging ‘memberships’.

A spokesperson did not respond to that question but confirmed in a statement that “a practice cannot charge an annual membership, administration or registration fee to guarantee a patient bulk-billed services”. 

A major investigation has uncovered how Australia’s healthcare system is being left open to financial exploitation.

“This would be a breach of the Health Insurance Act,” the spokesperson said. 

The spokesperson said the department “takes allegations of non-compliance very seriously, and where concerns are raised they are reviewed in accordance with the department’s compliance assessment procedures”.

Dr Faux said previous court cases had established that clinics were not allowed to charge additional fees while bulk-billing, but the government was yet to test in court the charging of membership fees that were charged on a different day to a bulk-billed service.

“A wise doctor would not want to be the test case in court,” she said.

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