Bulk-billing GPs accused of Medicare breach by also charging patients

[purpleduck]

https://www.abc.net.au/news/2024-09-05/gp-bulk-billing-memberships-medicare-breach/104305830

I am filthy that this is happening  I am posting here in case anyone attends a GP practice that does this so they can consider reporting it. 

I am also “amazed” that GP practices don’t seem to be aware that this is illegal? I get the paperwork and regulations are heavy for these kinds of services/businesses, but this is literally charging for what should be a free service. Surely someone should have picked up that this isn’t allowed???

[LifesGood]

But is this happening because bulk-billing does not cover the GP clinic's costs? I have some sympathy for them, but I don't think they should be charging pensioners and students any fees.

[Moomintroll]

I didn't realise it was illegal.  I've seen it for years here.

I'm still (always) peeved that those of us who don't attract bulk billing now pay $90 or so out of pocket in my city. Bulk billing is mostly only available to pensioners/HCC and even then only at a few places. $90+ is too much and I definitely avoid going to the doctor.  

[purpleduck]

1 minute ago, LifesGood said:

But is this happening because bulk-billing does not cover the GP clinic's costs? I have some sympathy for them, but I don't think they should be charging pensioners and students any fees.

But there are other ways to recoup costs. Yes it means that other patients may have to pay higher amounts, or they need to find other ways to boost income. But to have to pay a premium to access a “free” service is wrong. 

I don’t think the system is perfect by any stretch of the imagination, but this is directly against the bulk billing Medicare rules. 

[LifesGood]

13 minutes ago, Moomintroll said:

I didn't realise it was illegal.  I've seen it for years here.

I'm still (always) peeved that those of us who don't attract bulk billing now pay $90 or so out of pocket in my city. Bulk billing is mostly only available to pensioners/HCC and even then only at a few places. $90+ is too much and I definitely avoid going to the doctor.  

Thats a horrendous amount. My GP charges around that before Medicare rebate.

[Missy_D2]

7 minutes ago, LifesGood said:

Thats a horrendous amount. My GP charges around that before Medicare rebate.

Mine is $114 before rebate. 
 

Sounds like Costco for medicine model. 

[dianalynch]

Our is $90 before rebate. GP practices are doing it tough right now, the rebates haven’t anywhere near kept up with costs. 

[Julie3Girls]

4 minutes ago, purpleduck said:

But there are other ways to recoup costs. Yes it means that other patients may have to pay higher amounts,

I agree that membership fees to access what is meant to be free health care is really wrong
But how much higher do you think they can go? Other patients can’t keep just paying higher amounts to subsidise bulk billing. People hit a breaking point and stop going to their GP. Although given the wait time to get a doctor appointment is a couple of weeks, maybe that is a good thing? (Sarcasm) 

I don’t think raising fees for non bulk billing is the solution.

it is pretty much impossible to find a bulk billing practice near me. Being out of pocket $60+ minimum for a dr appt, combined with the difficulty to get an appointment, people simply don’t go. Head to emergency instead.

[purpleduck]

Just now, Julie3Girls said:

I agree that membership fees to access what is meant to be free health care is really wrong
But how much higher do you think they can go? Other patients can’t keep just paying higher amounts to subsidise bulk billing. People hit a breaking point and stop going to their GP. Although given the wait time to get a doctor appointment is a couple of weeks, maybe that is a good thing? (Sarcasm) 

I don’t think raising fees for non bulk billing is the solution.

it is pretty much impossible to find a bulk billing practice near me. Being out of pocket $60+ minimum for a dr appt, combined with the difficulty to get an appointment, people simply don’t go. Head to emergency instead.

I completely agree!! I don’t have the answer, or the data to know how these practices are getting their income. It’s complex and involves Medicare, the government, budgets and funding that I have never had to think about. We have been fortunate lately to not have any appointments to go to, and our local practice has always bulk billed the kids. 
 

[LemonMyrtle]

They should just say “after your third appointment we will bulk bill you for the rest of the year”. That would cover their admin fees. A membership is just a cash grab because so many people would pay it, and then only need the doctor once or twice a year. What a scam.

Our doctor is about $42 out of pocket. But our kids (and concession card holders etc) are bulk billed and they see the doctor the most, so I’m happy with the fees.

[Bornagirl]

Ours is $80 oop.   Our low income adult daughter, however, is either bulk billed, or only $20 oop depending on the doctor. When she got a severe case of Glandular Fever about ten years ago, she just happened to see the head of the clinic (one of the owners) who couldn't spend enough time with her.

 

Ours (woo hoo) allows for online repeat scripts for $20 for up to three, which really frees up the time I spend with the GP, and I'm not revolving my appointments about needing them.  Interestingly they now have GST added, whereas they didn't for a few years.  I then send the emailed scripts to the chemist who adds them to my account,  Love it.

[Meepy]

This is unconscionable.  A membership fee for medical treatment.   Be transparent - these places don’t bulk bill so they are misrepresenting their businesses.  Should be in trouble for misleading and deceptive conduct by the ACCC as well as from the Health Services Commissioner.  It is fraud, pure and simple.

I agree that the amount for bulk billing is too low but be transparent about your extra charges.  Don’t rip off the vulnerable in this way.

[nom_de_plume]

5 hours ago, LifesGood said:

But is this happening because bulk-billing does not cover the GP clinic's costs? I have some sympathy for them, but I don't think they should be charging pensioners and students any fees.

I wish they would stop rolling out this trope. GP's and clinics are not poor. Yes, they're the lowest paid specialty and potentially not valued as much as they should be. They're also not immune to the cost of living increases and it's true rebates and bulk billing incentives have been stagnant for a while. This is eating into profit margins but it is still a lucrative and profitable industry. 

Source: until relatively recently I was still a bookkeeper for many people working in the medical profession. I don't know of any GP's (unless they are semi-retired and only working one day per week or similar) who clear less than $200k per year. A full-time GP who exclusively bulk bills (and none of them do) would still take home at least $150k based on any of the admin fee (percentage of billings or receipts) arrangements I am aware of.

[MoukMouk]

3 minutes ago, nom_de_plume said:

I wish they would stop rolling out this trope. GP's and clinics are not poor. Yes, they're the lowest paid specialty and potentially not valued as much as they should be. They're also not immune to the cost of living increases and it's true rebates and bulk billing incentives have been stagnant for a while. This is eating into profit margins but it is still a lucrative and profitable industry. 

Source: until relatively recently I was still a bookkeeper for many people working in the medical profession. I don't know of any GP's (unless they are semi-retired and only working one day per week or similar) who clear less than $200k per year. A full-time GP who exclusively bulk bills (and none of them do) would still take home at least $150k based on any of the admin fee (percentage of billings or receipts) arrangements I am aware of.

Reminds me of the old “is $100k a year a high salary or not” threads.

So $150-200k as a self employed business owner or contractor. So no super, no annual leave, no sick leave. And having to pay say at least $6k a year in insurance, then college fees, and self funded compulsory CPD 50 hours each year which is more unpaid time off work. I pay my practice manager $120k a year plus super. No wonder people don’t want to become GPs. Especially now everyone is so much older coming out of medical school and having huge university debts. 

[purplekitty]

9 minutes ago, MoukMouk said:

Reminds me of the old “is $100k a year a high salary or not” threads.

So $150-200k as a self employed business owner or contractor. So no super, no annual leave, no sick leave. And having to pay say at least $6k a year in insurance, then college fees, and self funded compulsory CPD 50 hours each year which is more unpaid time off work. I pay my practice manager $120k a year plus super. No wonder people don’t want to become GPs. Especially now everyone is so much older coming out of medical school and having huge university debts. 

The years of non-earning and accumulating a huge HECS debt,

[barrington]

13 minutes ago, MoukMouk said:

Reminds me of the old “is $100k a year a high salary or not” threads.

So $150-200k as a self employed business owner or contractor. So no super, no annual leave, no sick leave. And having to pay say at least $6k a year in insurance, then college fees, and self funded compulsory CPD 50 hours each year which is more unpaid time off work. I pay my practice manager $120k a year plus super. No wonder people don’t want to become GPs. Especially now everyone is so much older coming out of medical school and having huge university debts. 

And no working from home privileges, either.

[RynandStompy]

31 minutes ago, barrington said:

And no working from home privileges, either.

That's incorrect. My old GP moved to telehealth/vid during covid and maintained a telehealth/vid day each week afterwards too. 

Edit - She wasn't bulk billing though 

Edited September 5 by RynandStompy

[nom_de_plume]

45 minutes ago, MoukMouk said:

Reminds me of the old “is $100k a year a high salary or not” threads.

So $150-200k as a self employed business owner or contractor. So no super, no annual leave, no sick leave. And having to pay say at least $6k a year in insurance, then college fees, and self funded compulsory CPD 50 hours each year which is more unpaid time off work. I pay my practice manager $120k a year plus super. No wonder people don’t want to become GPs. Especially now everyone is so much older coming out of medical school and having huge university debts. 

Yes that's true, but to play devils advocate - other than the size of the HECS debt it's no different to a lot of other professionals working as contractors. I completely understand why many choose higher paying specialties over general practice though.

35 minutes ago, barrington said:

And no working from home privileges, either.

This is not true. With the rise of telehealth, many GP's do part of their day/week consulting from home. 

They're a different speciality (emergency medicine), but the virtual ED is staffed by doctors working from home.

[MoukMouk]

4 minutes ago, RynandStompy said:

That's incorrect. My old GP moved to telehealth/vid during covid and maintained a telehealth/vid day each week afterwards too. 

Edit - She wasn't bulk billing though 

There’s a real limit for what you can do with Telehealth. Also in covid you were only meant to do Telehealth via bulk billing. How do check a blood pressure? Swab a throat? Palpate a prostate gland or a sore tummy? Biopsy a suspicious mole? Depending on your practice yes a lot can be done but a lot can’t. And it’s procedures that make money because of how Medicare is set up. Part of why female GPs tend to earn less. They are good at the “ talking” stuff which isn’t recognised by proper remuneration.

[STBG 2]

30 minutes ago, RynandStompy said:

That's incorrect. My old GP moved to telehealth/vid during covid and maintained a telehealth/vid day each week afterwards too. 

Edit - She wasn't bulk billing though 

COVID times should not be discussed as though it was the norm.

So many people got much sicker during lockdown because telehealth is just not suitable for so many medical conditions.

[Prancer]

I think it is terrible you are meant to pay any sort of clinic fee just to be able to see a doctor.  The lack of doctors taking new patients mean people feel forced into paying.  What it you don’t like the dr and want to go somewhere else?  Or you move?  Or the doctor moves.  There goes your money.

I get why charging people who can afford it seems a good idea.  But those loo,I g for bulk billing generally cannot afford it.  I was sick on the weekend.  I paired $125 for the doctor and $20 for the medication to fix me.  So $100 out of pocket after Medicare.  Now I can afford this, but so many people out there that don’t have a spare $100 laying around.  

[BoyMum2]

So are children meant to be bulk-billed? 
Our family GP charges $90 for adults and $75 for kids. Mine are 4 and 6.

 

[Meepy]

No, it depends on the practice.

[RynandStompy]

Re the telehealth aspect , I didn't mind it and actively selected it for routine calls vs in person for the other. And she had an established clientele, many who used to work in cbd and now mainly wfh ourselves, who found it convenient.

However I agree that using video or telehealth is less accessible for bulk bill patients, many of whom may have multiple intersecting health conditions where an in-person consult is preferred by both. Or they may have less money to pay for internet/laptop set up to get best value out of the video consult.

[STBG 2]

9 minutes ago, BoyMum2 said:

So are children meant to be bulk-billed? 
Our family GP charges $90 for adults and $75 for kids. Mine are 4 and 6.

 

incentives are paid to GP practices to bulk bill but I guess if they were worth it then more would BB children. That said all those in our area and in the area we used to live in BB under 16 even if they are not a BB clinic.

I am $45 OOP at mine, they charge $90, any GP who charges more than $135 for a standard consultation is seriously having a lend.