Nearly 100 clinics charge annual fees for bulk-billed services; experts slam ‘double dipping'
- Replies 13
In the age of rising healthcare costs and the ever-present need for accessible medical services, bulk billing has been a hope for many Australians, particularly those who often rely on frequent medical care.
Bulk billing minimises out-of-pocket expenses, ensuring that healthcare remains affordable and accessible.
However, a recent investigation has revealed a concerning trend that could undermine the very foundation of this system, leaving many patients, especially seniors, facing unexpected charges.
Bulk-billing involves a general practitioner (GP) billing Medicare directly and accepting the Medicare benefit as full payment for the service, meaning the patient does not have to pay anything.
Recent reports have uncovered that nearly 100 GP clinics across Australia have asked patients to pay annual membership fees to access bulk-billed services.
This alarming development has raised eyebrows and sparked outrage, as it appears to be a clear breach of Medicare rules.
One such clinic in regional Victoria has been charging patients between $220 and $330 for an annual fee, which they claim grants access to bulk-billed medical care for a year.
Experts have labelled this practice 'double dipping', including Peter Breadon from the Grattan Institute, who argued that it is dishonest and against the rules.
‘In these places with fewer GPs, you're much less likely to get bulk-billed care. And these are often the places where people are also more likely to be disadvantaged and more likely to be sicker,’ he said.
‘So it's a really perverse outcome that a lot of the communities with more illness and more disadvantage often have less bulk-billing and less GP services to go around.’
In November last year, the federal government tripled the bulk-billing incentive payment it paid to doctors for patients and consultations that met certain conditions.
Medicare pays a higher rebate for bulk-billed patients who meet these conditions than it does for private patients.
The Australian Government's Services Australia website clearly states that bulk-billing should not involve any payment from the patient, as the Medicare benefit is accepted as full payment.
For seniors like Mildura pensioner Sue Watson, who requires regular GP visits for complex health issues, the upfront cost of a membership fee is simply unaffordable.
‘[Bulk-billing is] supposed to be free healthcare,’ she said.
‘It totally negates the purpose of a bulk-billing clinic,’
Ms Watson mentioned that she and her partner could not cover the $330 upfront fee for the bulk-billed service due to their pension income and limited savings.
Many regional areas across Australia lack bulk-billed services, and introducing membership fees only exacerbates the problem.
It creates a perverse outcome where communities with higher rates of illness and disadvantage have less access to affordable GP services.
The Federal Health Department has stated that it takes these allegations seriously and that charging additional fees while collecting government rebates is not allowed.
Clinics found engaging in this practice could be required to repay any government rebates they have received and barred from receiving further incentives.
Despite the clear rules, some patients are willing to pay these fees, which may still be cheaper than paying for private consultations.
However, this does not excuse the practice, which could distort government data on bulk billing and mislead the public about the true cost of healthcare.
In April, Cleanbill released data indicating a growing trend of clinics receiving government rebates while simultaneously imposing membership fees on patients.
The report identified at least 98 clinics nationwide that charged subscription or membership fees for bulk-billed services despite regulations prohibiting such practices.
Medical billing expert Margaret Faux described this issue as ‘rampant’ but challenging for the government to identify.
‘[The extra fee] doesn't go to the government, so they don't see it. If it's tapped on a separate EFTPOS machine, they have no visibility over it,’ she explained.
The data from Cleanbill revealed that clinics charging membership fees had an average fee of $77.94, with Tasmania having the highest average at $167 and South Australia the lowest at $60.
Dr Faux expressed concern that these membership fees might skew government statistics on bulk billing.
‘All their bulk-billing is dropping into the bulk-billing statistics that the government periodically trumpets and says, you know, 80 per cent, or whatever it is now, of GP services are bulk-billed, meaning patients did not pay any money,’ she added.
‘And that is not true. They did. It was just called something else.’
The federal government reported that 79 per cent of GP visits were bulk-billed in May.
The ABC inquired with the federal health department whether it had conducted audits on bulk-billing clinics to check for membership charges.
While no direct answer was provided, a spokesperson confirmed that practices are prohibited from charging annual membership, administration, or registration fees to ensure patients receive bulk-billed services.
‘This would be a breach of the Health Insurance Act,’ a spokesperson said.
The department takes allegations of non-compliance very seriously, and where concerns are raised, they are reviewed by its compliance assessment procedures.
Dr Faux explained that prior court rulings had determined that clinics are prohibited from imposing extra charges when bulk-billing.
However, the government still needs to address in court the issue of membership fees charged on days separate from the bulk-billed service.
‘A wise doctor would not want to be the test case in court,’ she said.
Have you or someone you know encountered a GP clinic that charges membership fees for bulk-billed services? How did it affect your access to healthcare? Feel free to share them in the comments below.
Bulk billing minimises out-of-pocket expenses, ensuring that healthcare remains affordable and accessible.
However, a recent investigation has revealed a concerning trend that could undermine the very foundation of this system, leaving many patients, especially seniors, facing unexpected charges.
Bulk-billing involves a general practitioner (GP) billing Medicare directly and accepting the Medicare benefit as full payment for the service, meaning the patient does not have to pay anything.
Recent reports have uncovered that nearly 100 GP clinics across Australia have asked patients to pay annual membership fees to access bulk-billed services.
Thousands of Australians face illegal membership fees for bulk-billed GP services. Credit: Shutterstock
This alarming development has raised eyebrows and sparked outrage, as it appears to be a clear breach of Medicare rules.
One such clinic in regional Victoria has been charging patients between $220 and $330 for an annual fee, which they claim grants access to bulk-billed medical care for a year.
Experts have labelled this practice 'double dipping', including Peter Breadon from the Grattan Institute, who argued that it is dishonest and against the rules.
‘In these places with fewer GPs, you're much less likely to get bulk-billed care. And these are often the places where people are also more likely to be disadvantaged and more likely to be sicker,’ he said.
‘So it's a really perverse outcome that a lot of the communities with more illness and more disadvantage often have less bulk-billing and less GP services to go around.’
In November last year, the federal government tripled the bulk-billing incentive payment it paid to doctors for patients and consultations that met certain conditions.
Medicare pays a higher rebate for bulk-billed patients who meet these conditions than it does for private patients.
The Australian Government's Services Australia website clearly states that bulk-billing should not involve any payment from the patient, as the Medicare benefit is accepted as full payment.
For seniors like Mildura pensioner Sue Watson, who requires regular GP visits for complex health issues, the upfront cost of a membership fee is simply unaffordable.
‘[Bulk-billing is] supposed to be free healthcare,’ she said.
‘It totally negates the purpose of a bulk-billing clinic,’
Ms Watson mentioned that she and her partner could not cover the $330 upfront fee for the bulk-billed service due to their pension income and limited savings.
Many regional areas across Australia lack bulk-billed services, and introducing membership fees only exacerbates the problem.
It creates a perverse outcome where communities with higher rates of illness and disadvantage have less access to affordable GP services.
The Federal Health Department has stated that it takes these allegations seriously and that charging additional fees while collecting government rebates is not allowed.
Clinics found engaging in this practice could be required to repay any government rebates they have received and barred from receiving further incentives.
Despite the clear rules, some patients are willing to pay these fees, which may still be cheaper than paying for private consultations.
However, this does not excuse the practice, which could distort government data on bulk billing and mislead the public about the true cost of healthcare.
A regional Victoria clinic is one of nearly 100 charging annual fees for bulk-billed services. Credit: Shutterstock
In April, Cleanbill released data indicating a growing trend of clinics receiving government rebates while simultaneously imposing membership fees on patients.
The report identified at least 98 clinics nationwide that charged subscription or membership fees for bulk-billed services despite regulations prohibiting such practices.
Medical billing expert Margaret Faux described this issue as ‘rampant’ but challenging for the government to identify.
‘[The extra fee] doesn't go to the government, so they don't see it. If it's tapped on a separate EFTPOS machine, they have no visibility over it,’ she explained.
The data from Cleanbill revealed that clinics charging membership fees had an average fee of $77.94, with Tasmania having the highest average at $167 and South Australia the lowest at $60.
Dr Faux expressed concern that these membership fees might skew government statistics on bulk billing.
‘All their bulk-billing is dropping into the bulk-billing statistics that the government periodically trumpets and says, you know, 80 per cent, or whatever it is now, of GP services are bulk-billed, meaning patients did not pay any money,’ she added.
‘And that is not true. They did. It was just called something else.’
The federal government reported that 79 per cent of GP visits were bulk-billed in May.
The ABC inquired with the federal health department whether it had conducted audits on bulk-billing clinics to check for membership charges.
While no direct answer was provided, a spokesperson confirmed that practices are prohibited from charging annual membership, administration, or registration fees to ensure patients receive bulk-billed services.
‘This would be a breach of the Health Insurance Act,’ a spokesperson said.
The department takes allegations of non-compliance very seriously, and where concerns are raised, they are reviewed by its compliance assessment procedures.
Dr Faux explained that prior court rulings had determined that clinics are prohibited from imposing extra charges when bulk-billing.
However, the government still needs to address in court the issue of membership fees charged on days separate from the bulk-billed service.
‘A wise doctor would not want to be the test case in court,’ she said.
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