The cost of after-hours home doctor visits to taxpayers has hit $245 million a year and 10 doctors have been referred for investigations into potential "inappropriate" billing practices for such visits this fiscal year.
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Answers to Senate Estimates questions on notice tabled last month show at least 10 doctors have been referred to the Professional Services Review this fiscal year for investigations into "potential inappropriate practice in relation to after-hours services".
But the federal health department was unable to give the Senate any more information, as it could prejudice ongoing investigations and audits.
It comes as audits of after-hours services claims has found some "incorrect claiming" by doctors, but did not unearth enough evidence to refer the matters to the Commonwealth Director of Public Prosecutions.
The growing use of subsidised after-hours home doctor visits has generated concern for a potential government cost blow-out, and among traditional GPs who compete with such services.
Answers to questions from Nick Xenophon Team Senator Stirling Griff show claims for after-hours home visits rose about 25 per cent a year for the four years to 2015-16, compared to a five per cent annual growth rate for other GP services during that period.
That has led to the cost of all "urgent after-hours" services to taxpayers more than doubling in the past five years, up from $103 million in 2011-12 to $245 million in 2015-16, the documents show.
Most of those claims were made for MBS Item 597 services, a subsidy for a doctor's "urgent attendance after hours" to a patient's home, but the department could not attribute the growth "to any one cause", despite "a widespread marketing of these services".
"Of the over 180,000 patients who received three or more urgent after-hours services in 12 months between 2014 and 2016, over 10,000 received no standard, in-hours GP care at all," the documents read.
"This suggests that some patients are substituting after-hours home visits for routine general practice care."
Dr Barbara de Graaff, of the Menzies Institute for Medical Research at the University of Tasmania, agreed.
Dr de Graaff this week published a paper showing the growth in Item 597 claims in the ACT amounted to a whopping 1057 per cent between 2014 and this year, compared to a 521 per cent rise in Tasmania and a 348 per cent rise in Western Australia in the same period.
She said that was mainly due to the ACT having the lowest rate of such claims before services were expanded in 2014, but the territory's low bulk billing rate may have also played a part.
"Some people may be saying isn't it good we are getting more medical care, but the question is whether this is providing food value for taxpayers' money," she said.
"The health budget is not a bottomless pit and one rising cost means less for another service, there's always an opportunity cost and we would suggest the current model for this service provision is not the best value."
National Association Of Medical Deputising Services president Dr Spiro Doukakis claimed the rise in home doctor visits was easing pressure on hospital emergency departments, citing a 2016 Deloitte study the association funded.
He also said the Medicare Benefits Schedule items review had found a "poor understanding of billing" across the medical profession, but the after-hours sector had responded with "education activity involving mentoring, seminars, online forums, technology and systems changes".
But Dr de Graaff's analysis showed there was no commensurate fall in ED presentations or "next day GP visits" where after-hours claims had grown, and the department's answers to the Senate said the Medicare data "does not support [that] argument".
The data actually showed such comparisons were inappropriate and suggested "many patients are substituting urgent after-hours services for routine general practice care".
"If a patient is more appropriately seen during the in-hours period, either an Medicare Benefits Schedule urgent after-hours item or an emergency department presentation would not be considered cost effective," the documents read.
