Government investigating bulk-billing National Home Doctor Service over Medicare billing

| 03.10,19. 04:11 AM |

Government investigating bulk-billing National Home Doctor Service over Medicare billing

Photo: National Home Doctor Service is an after-hours bulk-billing medical service. (Supplied: 13 Sick)

The National Home Doctor Service has built a business empire on a simple promise — it will send a bulk-billing GP to your front door at any hour of the night, almost anywhere in the country.

It is a comforting and convenient option for the elderly and parents with sick children, and has helped the company become an international operation with 800 doctors on its books and annual revenues above $54 million.

But now the medical juggernaut, which has previously counted former federal health Minister Michael Wooldrige and former Labor senator Sam Dastyari among its directors, is being investigated by the Commonwealth watchdog tasked with weeding out inappropriate Medicare billing.

ABC Investigations can reveal the Director of Professional Standards Review, Julie Quinlivan, has launched a probe into whether the National Home Doctor Service "knowingly, recklessly or negligently" allowed some of its doctors to engage in "inappropriate practice" in relation to Medicare billing.

Professor Quinlivan launched the investigation after a receiving a request from Medicare in June last year to examine whether the company's doctors breached Health Insurance Act rules between September 2016 and August 2017.

But the company is seeking to thwart the investigation through a legal challenge in the Federal Court, arguing it cannot be held accountable for its doctors' actions because they are contractors rather than employees.

Concerns over bulk-billing

National Home Doctor Service, which is also known as 13Sick, has declined an interview.

In a statement, the company's chief executive officer, John Pappalardo, said the investigation related to doctors billing Medicare for "urgent" consultations.

"We are confident that we have at all times met the expectations of the Professional Services Review and the governing legislation," he said.

The investigation comes almost two years after a Department of Health taskforce raised concerns about a 170 per cent increase in after-hours bulk-billing across the medical profession in the five years to 2015-16.

"The growth in the provision of urgent after-hours services appears not to be driven by increasing clinical need for these services, but has coincided with the entry of new businesses into the market with models that promote these services to consumers, emphasising convenience and no out-of-pocket costs," the taskforce said in its final report.

"Some practitioners are claiming these services for patients whose conditions are not urgent and could more appropriately be managed through ordinary GP attendances."

Probe part of push to protect Medicare integrity

The Director of Professional Standards Review regularly investigates and takes action against doctors found to be inappropriately billing Medicare for after-hours consultations.

It is unclear from public documents exactly what kind of inappropriate practices Director of Professional Standards Review is investigating, and there is no suggestion the National Home Doctor Service, its directors or staff have broken the law.

Howard government health minister Dr Michael Wooldridge joined the company's board in May last year and is believed to have resigned in June.

He declined to comment.

Former Labor senator Sam Dastyari, who also declined to comment, was director from June 2018 until April this year.

Neither of the former politicians had a role in the day-to-day running of the company and there is no suggestion either had any involvement in inappropriate practices.

Court documents filed show Ms Quinlivan decided to pursue the investigation after meeting with 15 doctors who worked with the company.

In July she told the National Home Doctor Service that her agency was establishing a committee to examine the conduct of 56 of the company's doctors.

The Director of Professional Standards Review is responsible for protecting the integrity of the Medicare Benefits Scheme and the Pharmaceutical Benefits Scheme.

Her agency can disqualify doctors from billing Medicare for certain types of consultants and ask them to reimburse payments they have claimed inappropriately.

In the 2017-18 financial year, the agency recovered almost $21 million in fees — double the amount in the previous financial year.

The National Home Doctor Service is seeking an injunction to stop Ms Quinlivan's investigation, arguing she does not have the power to investigate the company because of the nature of its business model.

"Though the process of review, the Professional Services Review has sought to establish a relationship of employee/employer between the doctor and the company," Mr Pappalardo said in his statement.

"We contend that these relationships do not constitute one of employment and the company has sought two independent opinions of Senior Counsel who have agreed with this position."

The Federal Government amended Medicare legislation to hold companies like the National Home Doctor Service accountable for its contracted doctors' inappropriate Medicare billing.

However the changes were not retrospective, and may not apply to the period being investigated.

The National Home Doctor Service is majority owned by Sydney-based private equity firm Crescent Capital partners.


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