The Xanax mistake that is still costing Medicare millions |
What if giving a patient half a Xanax before minor eye surgery qualified as an anaesthetic service under Medicare?
That’s exactly what happened after a 2018 Federal Court decision that redefined “anaesthetic services” – and taxpayers are still footing the bill.
What if giving a patient half a Xanax before minor eye surgery qualified as an anaesthetic service under Medicare?Credit: Getty Images
Sydney ophthalmologist Dr Andrew Chang performed delicate eye procedures such as intravitreal injections, where a fine needle is placed into the eye to inject or remove fluid. Two Medicare items applied: for procedures without anaesthetic services, and another, paying 60 to 70 per cent more, for procedures that required them.
The higher-paying item was routinely billed by Dr Chang’s clinic after patients were given a single 0.25 mg tablet of alprazolam (Xanax) about half an hour beforehand. There was no anaesthetist, no monitoring and no assessment of whether the patient needed medication to tolerate the procedure or what their individual risks from taking the medication might be.
When the insurer, Bupa, challenged the claims, the Federal Court (and subsequently the Court of Appeal) sided with the doctor. The dispute turned on a question of legal interpretation: what do the words “requiring anaesthetic services” mean?
The Federal Court took an expansive view – that any calming or sedating measure, in any dose, by any route, by any clinician, could count.........