Medicare billing, law and practice: Complex, incomprehensible and beginning to unravel


Holding up a mirror to Medicare – do we like what we see?


“This article is one for the serious Medicare, medical billing and health insurance nerds. In it I have unpacked the Australian Medicare and medical billing legislation and demonstrated where the gaps are in painstaking, granular detail. It’s a dense academic text (be warned), but I have included many real world absurd medical billing practices and stories in the tables and footnotes. I have not suggested solutions yet, they will come later as my PhD progresses in an orderly academic manner, but what I and my co-authors have done is written the first ever compendium of 40 years of legal tinkering and presented the consequences and manifestations of that tinkering including increasing out of pocket costs for consumers, the newfound industry of self-appointed experts in medical billing and the ineptitude of the desperate scatter gun approaches to reform. It’s called ‘Medicare billing law and practice: Complex, incomprehensible and beginning to unravel.’ Speaks for itself! Thanks for reading.”
Margaret Faux, 10 June 2019



Abstract: Australia’s Medicare is still widely considered one of the world’s best health systems. However, continual political tinkering for forty years has led to a medical billing and payment system that has become labyrinthine in its complexity and is more vulnerable to abuse now, from all stakeholders, than when first introduced. Continuing to make alterations to Medicare without addressing underlying structural issues, may compound Australia’s health reform challenges, increase the incidence of non-compliance and expenditure and thwart necessary reforms to develop a modern, data driven, digitally informed health system. For the medical practitioners who are required to navigate the increasing complexity and relentless change, they will remain at high risk of investigation and prosecution in what has become an anarchic operating environment that they cannot avoid, but do not understand.

The full article is now on a pre-print server and submitted to a health/law journal for peer review.
Read the full article here.

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