Medicare Fraud
The ABC’s 7.30pm report and Nine newspapers recently aired an exposé on Medicare fraud and the findings have rocked taxpayers and the health profession. Allegations of individuals rorting the system by medical and allied health care practitioners have been rife for many decades but until now there has been no political appetite to investigate and have been glossed over.
Medicare expert, Margaret Faux was driven to expose the level of the problem and devoted her PhD to an analysis of the evidence. The revelations are shocking with estimates that $8bn or 30% of Medicare’s annual budget is being lost to inappropriate billing. https://www.abc.net.au/news/2022-10-17/medicare-leakage-fraud-waste/101537016
The joint investigation uncovered instances of charging for services that were not rendered such as billing for consultations at aged care facilities when residents were sleeping; radiologists claiming reimbursement for two procedures when conducting a single CT brain scan; and a surgeon billing a patient for a specialist consultation which was in fact a one minute telephone call to cancel surgery with no therapeutic value.
An anonymous specialist surgeon has also suggested extensive Medicare fraud also exists in the form of billing for services which have no medical indication. Examples were gastroscopy and colonoscopy, joint arthroscopy, cardiac angiography and radiological procedures.
The response from the AMA has been defensive, calling it an “unjustified slur” on the medical profession based on “grossly inflated,” figures. The AMA regards it as an attack on the vast majority of doctors who are doing the right thing. https://www.ama.com.au/media/ama-statement-medicare-allegations#:~:text=The%20AMA%20is%20extraordinarily%20disappointed,by%20health%20professionals%20including%20doctors.
However, the evidence uncovered by the media in fact suggests that inappropriate billing is far more widespread than previously thought.
Encouragingly, Federal Health Minister, Mark Butler, is taking the allegations seriously. He has already requested a review by the department of health into the allegations made by Dr Margaret Faux as well as its own compliance systems. https://www.abc.net.au/news/2022-10-18/mark-butler-independent-investigation-medicare-misuse/101546236 There has been a call for a Royal Commission into Medicare fraud. This is driven by a concern that Medicare and the wider health system are currently in crisis and can ill afford to waste such critical funding.
