INDEFINITE REFERRALS
This article is adapted from one which appeared in the Medicare Australia magazine ‘Forum’ which is aimed at practitioners.
When an Indefinite Referral is written
GPs can write Indefinite Referrals for the ongoing treatment of patients with chronic conditions. An Indefinite Referral is appropriate where a chronically ill patient is in the continuing care and management of a specialist or consultant physician for a specific condition, for example, glaucoma.
If an Indefinite Referral is already in existence, the specialist should not request a new referral and a referring practitioner should not issue one, unless a new condition has developed. The object of the Indefinite Referral is to save the patient the expense of a GP visit simply to get a referral for ongoing treatment.
In addition, a new referral enables a specialist to claim an ‘initial consultation’ rate which is higher than for ongoing consultations. The Indefinite Referral means that routine visits to manage the chronic condition can only be claimed by the specialist at the ongoing consultation rate.
Important:
• The renewal of a referral for the same condition does not indicate the start of a new course of treatment where the specialist can itemise another initial consultation.
• This situation changes if the condition changes and a new referral is then required.
Further information can be obtained from Medicare on 132 150.
TAKING OR SENDING PBS MEDICINE OVERSEAS MAY BE ILLEGAL
It is illegal to take or send PBS (Pharmaceutical Benefits Scheme) subsidised medicine out of Australia for reasons other than personal use of the personal use of someone travelling from Australia with you.
The PBS ensures that all Australians have affordable access to a wide range of prescription medicine; however, sometimes this medicine is taken or sent overseas for re-sale or for relatives who may not be able to obtain this medicine in their country. Such activity is illegal, has potential health implications and could also affect the sustainability of the multi billion dollar PBS. People who engage in this illegal behaviour risk fines of up to $5000 and two years imprisonment.
Before taking or sending PBS subsidised medicine overseas you should:
• Talk to your doctor and discuss the medicine you will need to take
• Contact the embassy of the country you are visiting to ensure the medicine is legal there
• Carry or enclose a letter from your doctor detailing what the medicine, is how much you will be taking and stating that the medicine is for your personal use
• Leave the medicine in its original packaging.
• There are also restrictions on the amount of PBS medicine you can take or send overseas – ask your doctor for details. For more information about taking or sending PBS medicine overseas visit medicareaustralia.gov.au, the got to ‘For Individuals’ > ‘Migrants and Travellers’ > ‘Travelling overseas’ > ‘Taking and sending PBS medicine overseas’.
HOW TO REPORT FRAUD
Each year millions of dollars of taxpayers’ money is lost due to fraud against health and welfare services and payments. The Australian Government Services Fraud Tip-off Line provides people with an easy means to report suspected fraud or noncompliance against Centrelink, Medicare, the Pharmaceutical Benefits Scheme or the Child Support Agency.
Examples of suspected fraud against Medicare Australia programs include:
• Making Medicare claims for services that were not provided
• Using someone else’s Medicare card
• Using an invalid concession card
• Forging prescriptions for PBS items
• Making PBS claims for pharmaceutical benefits that were not provided
• Swapping PBS prescription items for other pharmacy items or goods
• Taking or sending PBS medicines overseas when it is not for your personal use or the person use of someone travelling with you.
If you have information about suspected fraud or non compliance please call the Australian Government Services Fraud Tip-off line on 13 15 24 (Monday to Friday between 0900 and 1645 Local Time). You can remain anonymous, and the information you provide will assist in ensuring the services support those who really need them.
For further information about the Tip-off Line, including how to report fraud using our online or postal forms, visit medicareaustralia.gov.au
An online reporting form is also at this address.
