How GPs become the subject of Medicare audit?

There are three reasons to get audited:

  1. Random audit by Medicare. This happens regardless of your billing practices, the number of items billed and the number of patients seen.
  2. GP’s billing practices are significantly different from those of his /her peers, GP sees an unusually high number of patients, unusual pattern of billings, seeing 80 or more patients in 20 consecutive days etc.
  3. Complaint (may be anonymous) from a nurse, another doctor or a patient.

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