The Shared Debt Recovery Scheme came into effect on 1 July 2019
Important information for GP registrars on the new Shared Debt Recovery Scheme
As of July 1, 2019, post-payment investigations into MBS billing can result in debt recovery not only from the primary debtor (the practitioner) but ALSO the secondary debtors (the organisation employing the practitioner).
The change was introduced because Medicare billing is often delegated to non-practitioners and can be influenced by organisational processes and policies. In some instances, this may lead to incorrect billing practices.
This means that primary responsibility for correct claiming still rests with the practitioner, but the employer also has an obligation to ensure that claims are not false or misleading.
To find out what this means for GP registrars, GPRA sought advice from the Department of Health on a number of questions in relation to this new Scheme:
Are GP registrars subject to the Scheme?
Yes. All health professionals who are eligible to provide Medicare Benefits Schedule (MBS) services hold primary responsibility for the correct claiming of Medicare benefits. A practitioner is granted a provider number to allow their patients to access these benefits on the expectation that these services are billed correctly.
Prior to the Scheme, if an audit found that there had been a false or misleading statement, the health professional would be held responsible, in most circumstances, for the full compliance debt. Under the Scheme this debt may now be shared.
Will a GP registrar be considered as the primary debtor and their employer as the secondary debtor?
The health professional will be considered a potential primary debtor under the Scheme.
A secondary debtor will, in most circumstances, usually be the organisation, such as a training practice, who employs or engages the health practitioner whose provider number was used to make the Medicare claims for which a debt is owed.
Will the debt to a GP registrar be apportioned in line with the percentage sharing arrangements for their MBS earnings as described in their employment contract?
In the first instance the Department is required to apply the default prescribed percentage (65% applied to the primary debtor and 35% applied to the secondary debtor).
The Department may consider whether it would be fair and reasonable to set a different percentage to the default. In making this decision the Department will consider a number of factors, including:
- Any contractual arrangements between the primary and secondary debtor
- What influence or control the secondary debtor may have had over the billing for the services under audit
- The responsibility of the practitioner to ensure correct billing
This means that the apportionment of benefits in a contractual arrangement will be considered (e.g. for those employed according to the NTCER; the primary debtor - GP registrar – share may be 44.79% and secondary debtor - employer share may be 55.21%), however, this is not the only factor that determines what percentage would apply.
Please note that the Scheme does not apply to:
- debts arising as a result of a false or misleading statement which can be shown to have been made by someone other than the practitioner without the knowledge of the practitioner; or
- debts arising where one party has, without knowledge of the other, engaged in criminal conduct (fraud) in relation to Medicare claims or billing.
A practitioner will be provided opportunities throughout the process to make submissions and provide information that they consider relevant to the making of a Shared Debt determination including issues related to record management. However, decisions the Department would make will be considered on a case-by-case basis.
It would be prudent for employers and practitioners to work together to minimise incorrect billing. However, primary responsibility continues to rest with the practitioner.
The Department of Health recommends that practitioners make use of the AskMBS advice service for providers seeking advice on interpretation of the Medicare Benefits Schedule items and rules and the Health Insurance Act 1973 and associated regulations. Providers can contact AskMBS via email at AskMBS@health.gov.au.
Practitioners may also wish to participate in online training to assist in ensuring they are billing correctly.
The Department of Health’s factsheet on the Scheme is available online.