Medicare Audit Anxiety is it fake or real what does the High Court think?



Medicare Audit Anxiety is it fake or real? We have asked this question in our last news alert article Do you find trouble in interpreting the MBS item numbers?. We need your feedback.

Please complete and share this important five-minute survey . We collect this de-identified data for the High Court of Australia.

Prior to the survey for decades many practices have told us it does affect the access and type of care that practitioners provide to patients.

It started for us when a female client in the 1990’s had set up private billing Women’s Clinic for pap smears. This is what female patients had demanded at the time in a patient survey the clinic had conducted. From Canberra, Medicare statistically audited her for doing ‘too many’ Pap smears compared the average GP. Many at the time were male GP’s. She was asked to pay it back or else face a full investigating.

This video shows that practice managers at a national practice manager conference last year, have (nearly unanimously) indicated there is an ongoing and serious problem see  Practice Managers expressing MBS item number concern video

This is a health issue and it is not just a money issue. We have raised this matter with the Government via the Australian Medical Association last year and have not received a response to date.

Practices have reported the audits, in the absence of relevant clinical guidelines, did influence how many pap smears or care plans they completed in a day regardless of clinical need. It influenced whether off labeling in the practice occurs or not and opioid prescribing behaviour.

Our question has always been what are the commonly agreed peer-reviewed guidelines you use in order to practice patient safe medicine. Are they easily accessible and reliable?


Recently the Courts have used peer-reviewed guidelines as the overarching basis for any complicated negligence claims made against practitioners.

‘Since about 2002, judges have had the benefit of some legislative guidance, phrased along the lines of “a professional does not incur a liability in negligence arising from the provision of a professional service if it is established that the professional acted in a manner that [at the time the service was provided] was widely accepted in Australia by peer professional opinion as competent professional practice”.

Source: A lawyer breaks down the negligence case that has alarmed doctors, Australian Doctor 24th April 2018

Guidelines are becoming a practitioner’s best friend. More publishing by the relevant Colleges is required to protect patients and providers as contextually clear, up to date and consistent deadlines are hard to find are not always at your fingertips when you are working in a busy practice.

high court

As an update to our national survey, we sent late last year to our readers, we have received many excellent interim results. We have more than exceeded the statutory minimum Medicare requires to deem a doctor or provider is engaging in ‘inappropriate practice’. So it may be argued our results are ‘statutorily’ from the Health Insurance Act are valid.

We raised this issue in 2011. Government representatives from the Professional Services Review did argue in the absence of anecdotal evidence it was left to speculation as to whether audit anxiety exists or not and whether it was harming patient care.  

This unique and independent study seeks to debunk the myth once and for all and we need your help. Please share this survey with your doctors, dentist, allied health and practice staff. Now is the time to send a real message to the highest order on the land.

This information will be used in an anticipated High Court ruling we have been approached to give evidence at.

What is the role of the Government and professional associations and their membership engagement will be a critical feature of this application?

surveyThis survey seeks to address this issue and why your feedback is critical to improving a patient’s timely access to affordable healthcare.

Please complete and share this important five-minute survey . We collect this de-identified data for the Federal Health Minister and High Court of Australia.

4 comments on “Medicare Audit Anxiety is it fake or real what does the High Court think?”

  1. Thanks David. A great site to visit and read your advice.

    Looking forward to seeing you sat the HPARA Conference at Surfers Mantra 26th May. Have you registered yet?

    Russell Broadbent

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