Investigation into Alleged Medicare Billing Issues at WA Hospital
Australia’s leading medical imaging provider, Integral Diagnostics, has announced it will conduct an external audit following allegations of improper Medicare billing at a public hospital in Western Australia. The investigation comes after reports surfaced that rebates were incorrectly claimed at the Kalgoorlie Health Campus, prompting concerns about billing practices.
Apex Radiology, a subsidiary of Integral Diagnostics, provides some imaging services at the hospital. The company has launched the audit to ensure there are no billing anomalies, even though it claims not to be aware of any issues on its part.
The WA health minister has referred the matter to the state’s corruption and crime watchdog, the Corruption and Crime Commission (CCC), after previously stating that a government investigation found no concerns. This decision was made in light of new information that has emerged.
Internal emails obtained by the ABC reveal that Integral Diagnostics had previously raised concerns about non-Medicare compliant billing and sought legal protection for its staff. These concerns have now led to increased scrutiny of the billing practices at the hospital.
Billing Practices Under Scrutiny
The WA Country Health Service (WACHS) is responsible for entering billings for some of the radiology services conducted by Apex Radiology. An email sent to WACHS staff last week, seen by the ABC, urged them to ensure they were complying with Medicare billing rules. The email listed several examples of improper practices to avoid, including:
- Entering incorrect Medicare billing codes that resulted in double-billing
- Charging for services not received
- Improperly claiming rebates for radiologist consultations when patients were not receiving those consultations
- Charging twice for CT scans
Integral Diagnostics company secretary John Merity stated that the company was “not aware of any billing issue on our part.” However, he added that the company was taking the allegations seriously and conducting an external audit as a precautionary measure.
In an ASX stock exchange announcement, Integral Diagnostics clarified that it does not directly benefit from any Medicare rebates at the Kalgoorlie hospital. The statement said that diagnostic imaging at the hospital is performed by WACHS staff, except for one MRI technician provided by Apex Radiology. It also noted that Apex Radiology receives a fee from WACHS for providing radiologist reporting services.
Government Response and Ongoing Concerns
WA Health Minister Meredith Hammat initially stated that an earlier investigation did not identify any concerns. However, she has since referred the matter to the CCC due to new information. She explained that her office received additional information, which was shared with the department, leading to a different view on the matter.
Ms. Hammat mentioned that the person who conducted the initial investigation was on leave but did not clarify why. She expressed confidence that those involved in the initial investigations are not in a position to influence current proceedings.
The CCC has been contacted for comment, and WACHS has also been approached for further details.
Broader Implications and Industry Standards
WA Opposition Leader Basil Zempilas expressed concern over the allegations, suggesting they could indicate a broader issue. He called on the Health Minister to provide more explanations.
Ms. Hammat reiterated that the reviews so far have not identified any wrongdoing at the Kalgoorlie hospital. She also stated that there is no information suggesting issues with bulk billing at other public hospitals or clinics.
Integral Diagnostics operates more than 150 radiology clinics across Australia and New Zealand. In a statement, the company emphasized its commitment to billing accuracy, describing itself as a leader in the industry. Mr. Merity highlighted the company’s responsibility to ensure the right people, processes, and systems are in place to achieve the highest standards of accuracy.
An internal company memo revealed instances where radiologists signed off on referrals to enable Medicare rebates for ineligible services. The company’s chief medical officer urged staff to avoid such practices due to the significant compliance risks involved.
The ABC understands that the concerns outlined in the memo are not related to the allegations at Kalgoorlie Health Campus. However, the situation underscores the importance of strict adherence to billing regulations in the healthcare sector.
