A public hospital and private medical imaging provider have been billing Medicare for some services which are not eligible for bulk billing, according to an internal memo obtained by the ABC.
The Integral Diagnostics memo circulated on June 4 said there were instances of radiologists signing off on referrals to enable Medicare rebates for ineligible services.
“This practice carries significant compliance risks for yourself as the radiologist and may be interpreted as inconsistent with Medicare requirements,” the memo said.
“Effective immediately, please refrain from co-signing referrals unless you are directly involved as the treating specialist responsible for the patient’s care.“
The ABC understands the concerns relate to the billing of Integral’s subsidiary, Apex Radiology, which operates at the Kalgoorlie Health Campus in WA’s Goldfields-Esperance region.
Integral Diagnostics’s subsidiary operates at the Kalgoorlie Health Campus in WA’s Goldfields region. (ABC Goldfields: Elsa Silberstein)
The radiology department is resourced by the public hospital, but operated by Apex, which provides imaging services like X-rays and other medical scans.
Integral Diagnostics managing director Ian Kadish denied having knowledge of any wrongdoing when approached by the ABC after the memo was circulated.
Ian Kadish has denied any knowledge of wrongdoing. (Supplied)
“Integral Diagnostics is not currently aware of any incorrect billing,” Dr Kadish said.
Some bills for Apex’s imaging services are entered into the system by WA Country Health Service (WACHS) staff.
Internal emails include discussions about implementing a clause to protect radiologists from any non-compliance for incorrect billing.
This is considered a normal arrangement according to the WA Department of Health, the ABC understands, in order to ensure practitioners aren’t liable for mistakes made by third parties billing on their behalf like WACHS.
An internal WACHS email sent on June 3, seen by the ABC, told employees to “please ensure that staff are aware of billing rules”.
The email noted several examples of improper billing practices to avoid, including charging for radiologist consultations that haven’t occurred, and double billing for CT scans.
“Please advise all staff that it is their responsibility to ensure correct examination codes are entered into the system prior to finalising an examination,”
the email said.
Integral Diagnostics and Apex communications show the companies raised concerns about Medicare rebate issues as early as 2022, and concerns have been taken to the Department of Health on several occasions since.
Shirley Bowen has been sent a letter by a separate private contractor highlighting its concerns. (ABC News: Courtney Withers)
A separate private contractor sent a letter on January 5 this year to Department of Health director-general Shirley Bowen highlighting their concerns.
“This model may constitute cost-shifting and dual Commonwealth funding, contrary to the [National Health Reform Agreement], and may not comply with WA Health’s obligations,” the letter said.
On May 19, WA Health Minister Meredith Hammat told parliament she had been advised there were “no concerns about how the Kalgoorlie health service has been conducting its billing” when questioned by WA Liberal health spokesperson Libby Mettam.
“There has been some consideration, but the director-general’s advice is that there is nothing irregular,” Ms Hammat said at the time.
But the minister has since changed her tone.
Meredith Hammat says she has sought advice and will make appropriate referrals. (ABC News: Keane Bourke)
“In light of new information … I have sought advice and will make appropriate referrals,”
Ms Hammat said.
“WA Health has also notified the Commonwealth Department of Health, Disability and Ageing of potential concerns regarding Medicare billing for diagnostic imaging services.”
Integral Diagnostics maintained it was not aware of any errors in its billing, but said it would cooperate with any scrutiny of its operations.
“We will thoroughly investigate the claims and fully support any enquiries the government is making,” Dr Kadish said.
WACHS referred the ABC to the health minister’s office when contacted for comment.
Libby Mettam has urged for more clarity from the health minister. (ABC News: Courtney Withers)
Libby Mettam said the seriousness of the allegations warranted an investigation by the state’s Corruption and Crime Commission, and urged for more clarity from the minister.
“We’re talking about very, very serious allegations where Medicare has been billed for treatments or consultations that patients have not received, or double billing as well,”
she said.
“The minister needs to come clean about what she knew about these very serious concerns, and what action she had undertaken as minister for health.”
