Doctor Billed Medicare for Services Not Received

billybrown on 02/10/2019 - 06:11
Last edited 04/10/2019 - 20:52

Hi guys

I was just checking my medicare online account through mygov and noticed my doctor charged Medicare for "ATTENDANCE BY A MEDICAL PRACTITIONER for the PREPARATION of a GP MANAGEMENT PLAN (GPMP)"

This was never done, I never received a GP Management Plan during my checkup.

Any ideas what's going on here, simple mistake? Common practice? Potential fraud? Have other people seen that their doctor has been billing medicare for odd things?

I obviously have nothing to gain from investigating this btw, nothing came out of my pocket, it was covered by medicare. (But I am paying tax dollars!!!)

Edit: I did go see the GP for a wrist injury that could potentially have a GPMP plan made, but it wasn't covered by as a chronic disease, and the GPMP was never made.

Financial

Comments

  • sleepy le beef on 02/10/2019 - 06:50

    Its a chronic disease management item, detailed here http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&qt=I…
    If you aren't being treated for this kind of illness maybe the wrong code was entered by the surgery. Best to check with them.

  • tightpike on 02/10/2019 - 06:55

    Did your gp give you a referral to see an allied health practitioner? A management plan is done before the referral.
    A management plan costs Medicare about $250+ consult.

    • sleepy le beef on 02/10/2019 - 07:31

      $146.55

    • billybrown on 04/10/2019 - 20:44

      He printed out a form for a referral i think, but said my issue wasn't covered anyway. So it wasn't useful to me at all, so i didn't sign the form or pursue it. (No idea why he printed one anyway)

  • RockyRaccoon on 02/10/2019 - 07:07
    -1

    Just for a laugh …. 

    Proof required otherwise it didn't happen…..

    But I am paying tax dollars!!!

    It's Ozbargain and we require these things 😀

    BTW Great you are checking

  • vikvance on 02/10/2019 - 07:14
    +8

    Any ideas what's going on here, is it potential fraud?

    It's interesting that the first thing you think about is "potential fraud".

    Usually, a person seeing something like this would think "hmmm … someone made a mistake". But you go straight to accusing the doctor of "fraud".

    • Kangal on 02/10/2019 - 08:22

      Fraud?
      THIS. IS. OZBARGAIN!!!!!

    • DuckKnight on 02/10/2019 - 08:24

      Watching ACA does that.

    • billybrown on 04/10/2019 - 20:42
      -1

      Seems like an odd mistake to make, the doctor would be the one entering what services you got not the receptionist or thing.

      But fair enough, might have just been an error. I'll try to use the mistake excuse if I'm ever in trouble with the tax office!

  • redforever on 02/10/2019 - 07:23

    Did you see your GP on that day in question?

  • BobD on 02/10/2019 - 08:14

    A doctor is supposed to discuss a CDMP with you and get you to sign it before billing and I think give you a copy of it.

  • paraneoplastic on 02/10/2019 - 08:35

    Had you gotten a GPMP your visit that day would've gone something like this:

    1). you came about 1hr prior to your actual visit with the GP
    2). A nurse / medical student woul have sat down with you and discussed a chronic health condition you have
    3). a 'plan' made to organise the 5 free allied health visists from medicare and how to allocate them
    4). GP appointment with them printing out 2 copies of the plan, 1 for you and sending a referral to whatever allied health you needed

    If not… It's eithe ra mistake or what a practice on the gold coast did when i was a med student, that is, do a psedu-GPMP without acutally sending any refrrals to claim the medicare

    was it a bulk billing GP you went to ?

    • billybrown on 04/10/2019 - 20:47

      Thanks for the helpful response. Didn't get any of those things, so GPMP definitely wasn't done.

      This psedu-GPMP is allowed? Seems to be just creating charges??

      Yes it was a bulk billed GP

      • paraneoplastic on 04/10/2019 - 22:05

        Sorry for the attrocious spelling mistakes (was typed on phone)

        Again, could've just been an error on the practices part.

        If not, 100% no. Not allowed.

  • Typical16-bitEnjoyer on 02/10/2019 - 10:16
    +1

    Obviously you asked your Doctor prior to posting this….right?

    So, what did they say?

    • dcep on 02/10/2019 - 11:54
      +2

      make appointment 1st

  • FirstWizard on 02/10/2019 - 12:09

    I've changed house and started seeing a new GP. At about the 3rd visit, he asked me if he's my primary GP. I said, "Yeah, I guess".

    Then he asked me questions on my medical history, medications I've had in the past that I remember of, allergies, regular medications etc., etc. took about 15mins and he took down notes on the system.

    A couple of months later I had the same charge on my Medicare history when I randomly checked.

  • beefabear77 on 06/10/2019 - 15:55

    I think this occurs a bit at bulk billing GP centres as I've seen this sort of thing in my own Medicare history. My favourite was being billed for a Mental Health Care Plan when I can assure you no such assessment or plan occurred.

    • solidweiner on 08/10/2019 - 00:22

      That's a bit worrying. If I were you, I would contact the clinic and ask for an explanation. A Mental Health Care Plan requires your signed consent before proceeding, and should not be performed otherwise. 1) it remains on your record which insurers can potentially ask you to declare if you apply for their products; and 2) it can only be billed every 12 months - so when and if you actually need one, this creates a headache for the GP who sees you at the time.

      To reiterate, I would definitely question why it was performed. Hopefully it was an error in billing, and not somebody rorting Medicare.

      To be fair though, not all bulk billing practices are like this. I'd like to hope so, anyway.

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