GPs often feel caught in the middle when this scenario arises. They can feel an obligation to help their patient who will otherwise be left out of pocket without a current referral.
However, there is no leeway in this situation. It is unlawful to backdate a referral and GPs should not agree to such requests. Under the provisions in the Commonwealth Health Insurance Act, stiff penalties can apply for making false or misleading statements in relation to Medicare. This can also lead to disciplinary action by AHPRA.
Further, backdating referrals can result in Medicare declining to pay Medicare benefits or requiring repayment of benefits if they have been paid incorrectly.
Requirements for valid referrals
A valid referral is required before a specialist can itemise the consultation so the patient is eligible for Medicare benefits.
To be valid a referral must be:
- in writing;
- signed and dated by the referring doctor;
- in date when the patient sees the specialist; and
- received before or at the time of the specialist consultation.
Referrals from a GP to a specialist last for 12 months unless otherwise specified. If the specialist on-refers to another specialist, the specialist referral is only valid for three months.
This is an excerpt from an Avant newsletter article & was originally published by Dr Walid Jammal, Senior Medical Advisor – Advocacy, and Andrew Vandervord, Practice Manager, Legal (NSW), Avant Law on 16th May 2017 in the Medical Observer & has been used with Avant’s permission.
