Wading through Molasses: A qualitative examination of the experiences, perceptions, attitudes, and knowledge of Australian medical practitioners regarding medical billing

Background The WHO has stated that all health systems haemorrhage money, citing one of the causes of financial leakage as non-compliant billing and fraud. In Australia, it has been estimated that leakage from Medicare caused by non-compliant medical billing may be 10-15% of the schemes total cost. Despite a growing body of international research suggesting that rather than deliberately abusing the health financing systems they operate within, medical practitioners may be struggling to understand complex and highly interpretive medical billing rules, there is a lack of research in this area in Australia. The aim of this study was to address this research gap by examining the experiences of Australian medical practitioners as they interact with Australias Medicare by engaging in conversations with them about their lived experiences conducting medical billing in grass roots practice. Method This study interviewed 27 specialist and general medical practitioners who claim Medicare reimbursements in their daily practice. Interviews were recorded, transcribed, and analysed using thematic analysis. Results The qualitative data revealed five themes including inadequate induction, poor legal literacy, absence of reliable advice and support, fear and deference, and unmet opportunities for improvement. Conclusion The qualitative data presented in this study suggest Australian medical practitioners are ill-equipped to manage their Medicare compliance obligations, have low levels of legal literacy and desire education, clarity and certainty around complex billing standards and rules. Non-compliant medical billing under Australias Medicare scheme is a nuanced phenomenon that may be far more complex than previously thought. Strategies to address the barriers and deficiencies identified by participants in this study will require a multi-pronged approach. The data suggest that the current system of ensuring compliance by Australian medical practitioners is not fit for purpose.