The private health insurance industry has applauded the Health Minister for consulting and then acting quickly to close a loophole allowing double dipping for skin lesion treatments.

Private Healthcare Australia CEO, Dr Rachel David, said consolidating the number of Medicare Benefits Schedule (MBS) items used to describe different types of skin procedures provides clarity while closing a claiming loophole used by a small number of doctors registering their rooms as ‘day hospitals’.

“Health insurers have seen cases where some individual doctors and practices have categorised simple procedures done under local anaesthetic as needing a theatre fee or day surgery admission, which means they can inappropriately bill twice – one bill to the Government and one bill to a health fund”, Dr David said.

“The new item codes clearly differentiate between small excision biopsies done under local anaesthetic in a doctor’s rooms, and more complicated procedures which may need a general anaesthetic or more specialised equipment requiring a hospital setting.

“Claims that patients could be facing higher co-payments as a result of the new item structure are ridiculous.  Patients needing small skin cancers removed can be reassured this is not going to happen.

“If under special circumstances a doctor does need to undertake one of these procedures in a hospital, all they need to do is fill out the correct paperwork and the claim can be processed as usual.

“The Minister should be congratulated for consulting with experts, including doctors’ groups, and acting quickly to end this rort which drives up the cost of private health insurance premiums and wastes taxpayers’ money.”

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