Can doctors make claims without my knowledge?

I was just looking at my online medicare statement for the last 12 months. In August last year I went and got a tetanus injection after I stood on a nail at the local hospital. It was a Saturday afternoon. The hospital rang the doctor to look up my records to see when I had last had one before they told me to come in. When I went in, a nurse gave the injection.

Anyway, on my statement, I've been bulk billed for an after hour consultation in consulting rooms. I never saw the doctor and the injection was at the hospital not his offices.

So, I guess I see why he bills for things like this, but surely I should have to sign off on it or something? Otherwise what stops doctors making random claims for people all over the place when they've not done anything?

Thoughts?

I'm not sure. But I only ever have to sign if I have to pay. Seems odd & I've often thought the same thing.

Pretty sure they can, but if they get caught out, medicarewon't just issue them the payment. They will send you something to sign and send back stating that you agree to have the payment issued to them. A GP I was seeing awhile back had this happen as it looks like his partner was doing the dodge and claiming for consults he wasn't doing.

I would ring Medicare and explain the situation to see if it's legal. If it's not, it's something they (medicare) need to be aware of.

It's happened once before, I may have even posted about it back then, probably 18 mths ago or more. Same practice, but I had a blood test just with the practice nurse. Didn't sign anything other than the S&N blood thingo and then discovered, about 6 months later that it was charged as a level B consult with the doctor. I should have checked into it then.

If you made only 10 extra claims a week for patients you didn't actually see, that's a pretty fair cash earner!

You will find the dr will have to sign the forms for authorisation even if he hasnt seen you, and therefore could charge.

Oh right, still not sure how it would qualify as level B when it's not a long consultation at all.....anyway I can see where some certainly could take advantage.

yeah not sure about that ausgirl.
i know my dr says to be "im going to charge this as a long consult if that is ok?"
and i dont mind - as it is over 15 mins

Ahhh I've got it!! My doctor must charge from when your appointment should start! Bhaahaha They are always terribly behind! Perhaps that was the day I waited 1.5 hours to get it!!

I would think it is fair enough to charge you if you see the nurse as they don't have a separate nurses fee as far as I am aware. So the doctor has to pay the nurses out of their pay ITMS. Although I do think the dr should at least just see you even if only for a minute if only to cover their bums legally. When I have just seen the nurse at the practice I go to, the dr pops out between patients to make sure everything's hunky dory.

You would have had to give your Medicare card at casualty. That was in effect giving consent to charge the consultation to Medicare. If you don't give your Medicare card they will bill you the full fee.

Some nurse things can be bulk billed - there is a special code. It's been a while since I've had anything to do with billing so I can't recall all the things they can bulk bill for. My memory is a little hazy but if the nurse doesn't have a provider number, it is bulk billed on the Dr's provider number but as a certain nurse task code.

Hopefully one of the practice nurses on here (and there are a few) can shed some light on it for you including if what they did is legal. My feeling is that it is NOT legal as I vaugely recall reading a case about a Dr who did this and got prosecuted (successfully). BUT, I could be wrong. As I said, it's been a loooooong time since I've done billing.

If you're not comfortable with it, feel free to call the rooms as ask them to explain it. You can call Medicare and they may chose to investigate.

I'd report it to Medicare. Doctors like that take so much money out of the health system that could be used much more effectively.


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I remember when we have done anything with the Nurse at the clinic that she always asked which Dr we were under, so it would be bulk billed against them. This was for things like immunisations, ear syringing etc

Nurse stuff they should be able to bulk bill for but I wouldn't think they could bill for the call from emergency where they looked up your records. Does the online medicare thingo have an item number against it?

Yep the hospital one where I had the tetanus needle was item number 05020 level B surgery after hours at consulting rooms. As for having to present my medicare card, nope. Not even when I saw doctor today and definitely not at hosptial. I actually asked if they needed it and was told no, it was on file already.


From MBS site:

:

---

5020 CONSULTATION AT CONSULTING ROOMS

Professional attendance at consulting rooms. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.

Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:

a) taking a patient history;

b) performing a clinical examination;

c) arranging any necessary investigation;

d) implementing a management plan;

e) providing appropriate preventive health care;

in relation to 1 or more health-related issues, with appropriate documentation.

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I would say looking up a medical history from home would be a stretch?

I think that looking up your file and calling it a 1 hour consult is a bit rich. He would be within his rights to claim for after hours but IMO 30 minutes is a reasonable charge not an hour.

Are you saying he was at home and you were in the ED? I read that excerpt from the schedule as you both being in the consulting rooms which clearly you weren't. A loooooooooong stretch.
Eta i get that it is difficult to run a practice with costs rising and Medicare reimbursement not rising but I think it would be more appropriate if he billed you a longer consultation next time he saw you rather than using an item number incorrectly.

I never saw him. I rang the hospital to ask whether I should come in for a tetanus shot. The said they'd look it up and call me back. They rang back and said they couldn't find anything in my records there and Doctor couldn't find anything either, so come in and have one just in case. I went and the nurse gave me the shot and looked at my foot where I had stood on the nail.
Would've been there 10 mins tops. Definitely never saw the doctor.

If you saw the hospital and not the clinic then no, the clinic can not bill you. A healthcare provider has a right to ask for relevant medical history and there should never be a charge for that (different if you're asking for it). In this instance, only the hospital has the right to bill you (or Medicare).

Out of curiosity, was the Dr who put through the claim on duty at the hospital? Either in person or in an on-call manner?

You won't ever be asked to sign a medicare form in hospital - although I think you sign something on admission and they use that for everything. But hospital billing is different to a clinic.

In a clinic setting you should be asked to sign for it before you leave but if you don't (for whatever reason) they can sign it on your behalf (citing the reason). We did this often when the system crashed and we had to do retrospective claims.

Yes he was the on-call doctor however I thought hospital was seperate to surgery. He owns the practice and has other doctors that work for him and he also has the contract for the hospital as a seperate thing.

If he's billing medicare for it, shouldn't it be billed as attendance in hospital? Perhaps he was at the practice doing files when they rang him?

Are you sure it's not the charge from the hospital visit? If he was the doctor overseeing the case (even from a distance) then that might be the way the hospital is charging the visit?

Don't know it seems very confusing!