Medicare Compliance Survey

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I am a health worker

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I have my Medicare records in front of me

I don't have my Medicare records right now

Please select as many of the following that apply. You can add extra details in the comments box at the end.

Let's start with COST

Please select as many of the following that apply:

My Medicare records say I was bulk billed and the ‘Cost to claimant’ says zero, but that is not true.

I paid more than my Medicare records say I paid.

The doctor told me there was no Medicare rebate for the service, so I paid upfront fees. But now I can see a bulk billed claim for the service on my Medicare records. Common example: psychiatrists charging for patients with ADHD.

Medicare and my private health insurer were billed for a minor procedure that I had. But I wasn’t admitted to a hospital and didn’t have it in an operating theatre. It was done in the doctor’s office. Common example: intravitreal injections by ophthalmologists, and surgeons cutting out small lumps and bumps.

My quote said "AMA Recommended Fee". I thought I was getting a discount because my doctor charged less than this fee.

Please select as many of the following that apply. You can add extra details in the comments box at the end.

Great. Now let's look at SERVICES

Please select as many of the following that apply:

I did not receive the service on my Medicare records

The service on my Medicare records is longer than the service I received. Common example: The phone call with my GP lasted less than a minute but I can see item 91891 ‘Phone attendance by a general practitioner lasting at least 6 minutes’.

The service on my Medicare records is different to the service I received.

I can see one or more of items 721, 723 and 732 on my Medicare records, but I don’t have a chronic medical condition.

I had a consultation with a GP and can see one of items 2700, 2701, 2715, 2717, 92112, 92113, 92116 or 92117 on my Medicare records. But I did not discuss my mental health with the GP at all.

My Medicare records say I had a telehealth consult (this means it was by video), but that is not true, it was a phone call.

I can see claims on my Medicare records while I was a public patient in a public hospital.

Please select as many of the following that apply. You can add extra details in the comments box at the end.

You're nearly done. Now let's look at WHO provided the service

Please select as many of the following that apply:

I have never seen the health professional named on my Medicare records.

The service on my Medicare records was provided by someone else. Common example: it says my doctor provided the service, but she/he was not there. A midwife or nurse did it.

Please select as many of the following that apply. You can add extra details in the comments box at the end.

Almost there, a little bit about X-rays, scans and blood tests

Please select as many of the following that apply:

The radiology company made me come back on two separate days for my two tests.

I only had one radiology test, but I can see multiple MBS codes on my Medicare records.

I am concerned about pathology tests on my Medicare records. Common example: My GP sent me for a covid test, but I can see results for influenza A and B and other things that I never discussed with my GP.

Here’s a question for people with private health insurance. You can add extra details in the comments box at the end.

My private insurer app says my procedure was no-gap, but that is not true. Common example: I paid an “administration fee” of $5,000 to the surgeon and another $2,000 to the anaesthetist.

I was not in any way limited by any severe systemic or significant disease at the time of my procedure, yet I can see item 25000 or 25005 on my Medicare records.

I spoke with the anaesthetist for less than 15 minutes before my procedure, yet I can see one of items 17615, 17620 or 17625 on my Medicare records.

The below information is available on your Medicare records. Just complete as much as you can.

Date

Medicare item code

Cost to claimant

Benefit paid

Total cost

The below information is available on your Medicare records. Just complete as much as you can.

Date

Medicare item code

Cost to claimant

Benefit paid

Total cost

Please select as many of the following that apply. You can add extra details in the comments box at the end.

Here are some basic questions about what happened during your visit.

Health industry workers, the following 8 options are for you:

I am never asked to sign anything or pay anything. I just walk out.

I was asked to sign a blank Medicare form.

My health practitioner used to just charge the gap, but now they charge the full fee.

When I was at the pathology collection centre, they asked me if I wanted an extra test.

My quote said "AMA Recommended Fee". I thought I was getting a discount because my doctor charged less than this fee.

Please select as many of the following that apply. You can add extra details in the comments box at the end.

Just a few more to go. You're nearly done...

Health industry workers, the following 8 options are for you:

I was charged a fee in a public hospital emergency department.

I was charged a fee and was bulk billed in a public hospital emergency department.

I was charged a fee while I was a public patient admitted to a public hospital.

The public hospital outpatient clinic said they wouldn’t see me without a named referral from my GP.

I do not have private health insurance, but my surgeon charged me a "Booking fee" to put me on the public hospital wait list for my surgery.

Please select as many of the following that apply. You can add extra details in the comments box at the end.

Here’s a few questions for veterans and people who have private health insurance.

My allied health provider (eg, physiotherapist) asked me to leave my private health insurance membership card with them.

My private health insurer told me my extras cover is all used up for this year, but I’ve hardly used it.

DVA said my entitlements are all used up for this year, but I know that is not correct.

Please select as many of the following that apply. You can add extra details in the comments box at the end.

This will take you less than 2 minutes. Promise!

I am a health worker

Medicare claims are being submitted for services that were not provided.

Medicare claims are being submitted for services that were longer than, or different to the services provided.

Everyone is charged a gap when they are bulk billed. Common example: we bulk bill item 23 and receive the rebate from Medicare, but our patients also pay $30 that the government can’t see because we process it through a separate EFTPOS machine.

Unnecessary services are being billed to Medicare. Common example: Everyone gets a care plan whether they need one or not.

Cosmetic services are being billed to Medicare by faking something medical. Common example: the real reason for the visit is regular cosmetic botox, but the patient’s blood pressure is always recorded to make it medical. Or for surgeons - claiming a cosmetic breast augmentation as a ruptured implant.

When a referral expires, we are told to create a fake one by changing the date before submitting the claim.

Our GPs sell their signatures on fake referrals. (Please add details, including the name of the portal they use and the amount paid per signature in the comments box at the end).

Please select as many of the following that apply. You can add extra details in the comments box at the end.

Just a few more to go. You're nearly done...

I am a health worker

When our patients turn up without a referral, we are told to make one up.

Our providers often bill the same service to multiple payers. Common example: The NDIS & Medicare, or a Workers Comp Insurer & Medicare.

We are pushing paid claims through to Medicare when no money has changed hands to artificially get patients to the safety net threshold.

I work in an aged care facility and regularly see the GPs billing Medicare for services they do not provide.

Our practitioners share their provider numbers, so Medicare does not know who actually provided the service.

Our surgeons / anaesthetists / obstetricians all charge "administration" fees over $500 and then double dip by also putting through a no-gap claim.

I have repeatedly reported my concerns to my boss but am ignored.

I am afraid to report my concerns.

Please select as many of the following that apply.

Great job! Here's the last set.

Please select as many of the following that apply:

I reported concerns to Medicare but never heard back from them