The plenary session to MIGA’s half day risk management education conferences was a claims hypothetical moderated by Professor Guy Maddern and supported by a panel of subject experts.

Over 900 doctors attended a MIGA Conference across the 2019/2020 Risk Management year and were informed, challenged and at times entertained by the plenary topic “Medicare – Does your dawg bite?”  This hypothetical, based on real claims experiences, has taken doctors through the process of a Medicare audit which begins with the data matching and compliance team at the Department of Health, through the Practitioner Review Program, a referral to the Director of the Professional Service Review and consideration by  PSR Committee and subsequently the Determining Authority. At each step of the process the experience with the agency or committee involved becomes less pleasant and the potential consequences from a finding of inappropriate practice in relation to Medicare billing can be more severe. Drawing on the Pink Panther series and Inspector Clouseau’s famous line “Does your dawg bite?” we discovered that it depends on who “owns” the dog.

The Department of Health has become more sophisticated in their data matching and has broadened their compliance focus from reviewing total and daily billings by general practitioners to include potential breaches in relation to the use of particular billing items and widened their scrutiny to include the billing practices of specialists. This Hypothetical was well timed to prepare doctors for an increase in audit activity.

The panel
We extend our thanks to the panel members from each state that joined the debate:

  • Professor Julie Quinlivan, Director of the PSR
  • Dr Caroline Phegan, previously a Medical Advisor with the Department of Health
  • Geoff Black, Wallmans Lawyers
  • Andrew Saxton, Meridian Lawyers
  • John Petts, Kennedys Law
  • Sacha Shannon, Minter Ellison
  • Members of MIGA Claims and Legal Services Team
  • Members of the MBS Review Taskforce or one of its Committees, including:
    – Associate Professor Alex Hunyor
    – Professor Michael Grigg AM
    – Professor Peter Hewett
    – Dr Lawrence Malisano
    – Dr Matthew McConnell
    – Laureate Professor Nicholas Talley AC

The evaluations 

  • Excellent. Good reminders about things we should have been aware of since we went into practice. (Medical Officer)
  • Very informative. A challenging topic, kept well on track. (Psychiatry)
  • Thought provoking. (Urology)
  • Informative. (ENT Surgery)
  • Very good. (Vascular Surgery, Dermatology)
  • Learnt a lot. Hopefully, thus far have not or likely to be affected. (Orthopaedic Surgery)
  • Excellent overview of issues pertinent to all medicos’ practice. Made me plan to be more proactive – understanding Medicare, MBS Codes and billing. (Ophthalmology)
  • Very helpful in pin-pointing areas to sort out. (Obstetrics and Gynaecology)
  • Excellent topic. Good audience interaction. (Anaesthesia)
  • Very relevant and unsettling. (Emergency Medicine)
  • Insightful, worrying. (Orthopaedic surgery)
  • Excellent as usual. (General Surgery)
  • By far the best Risk Management workshop I have attended. (General Practice)
  • Big topic, good overall coverage, well moderated. (General Surgery)
  • Very entertaining, entirely relevant and important to day to day activities. (General Practice)

What’s next?
Our 2020/2021 Conference series is on hold as a result of COVID-19 restrictions, but we encourage you to visit REO (www.reo.miga.com.au ) where you can access our online risk education.  There are a range of module topics which you can undertake at a time convenient to you and at your own pace.

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