The AMA has welcomed the Government’s announcement that a departmental review found no evidence to support media reports of widespread Medicare fraud.
Federal Health Minister Mark Butler confirmed on 5 November 2022, that a departmental review found there was no support for claims that that up to 30% of the Medicare budget was being ‘rorted’ by doctors and other health professionals.
“Australians know that the overwhelming bulk of Australia’s doctors and health professionals are honest, hardworking and comply with Medicare rules. But they also understand that, after nine years of cuts and neglect, every dollar in Medicare is precious and must be spent directly on patient care,” Minister Butler said.
“My department has provided a report on the existing compliance efforts, along with a rundown of the various estimates on the scale of the problem from the ANAO and others, [and that] report found no evidence of the $8 billion in Medicare fraud and inappropriate billing estimated by Dr Faux.”
However, as a 2020 Australian National Audit Office report estimated the value of Medicare non-compliance at between $366 million and $2.2 billion a year, the Government has appointed respected health economist Dr Pradeep Philip to conduct an independent review into the integrity of the system and its mechanisms.
The Philip Review will assess the possible value of fraudulent, non-compliant or over servicing risks in Medicare and provide a methodology and evidence-based estimate of the likely value of non-compliance.
As the Lead Partner at Deloitte Access Economics and a former Secretary of the Department of Health and Human Services in Victoria, Dr Philip has a long history working at the highest levels of public policy in Australia.
“I’ve asked Dr Philip to measure and report on the true extent of non-compliance in Medicare and identify fixes to protect the integrity of the system, for all who use it,” Minister Butler said.
“All governments must apply strict compliance standards to any publicly funded system – including Medicare – to ensure that the small minority that do the wrong thing are picked up quickly and dealt with.”
Dr Philip will provide an interim report to the Government by 31 January 2023, with the final report to be submitted by 28 February 2023.
AMA President Professor Stephen Robson said the announcement was a welcome one for doctors across the country who had reported mental distress following the media reports.
“The AMA has acknowledged consistently that while some fraud does occur, the vast majority of doctors are doing the right thing. And we have seen the mental toll these reports have taken on Australia’s doctors,” Professor Robson said.
“We have seen and heard from general practitioners and non-GP specialists who have told us how upsetting these stories are. They have told us about being confronted by angry patients. This is a direct result of inaccurate and misleading media reports.
“The AMA analysed the documentation these media reports relied on and like the department found nothing — not a skerrick of evidence — to support the claims made in headlines splashed across some news organisations.
“We have relied on reputable sources, and we’ve seen multiple experts, including former head of the MBS Review, Professor Bruce Robinson; immediate former head of the Professional Services Review, Professor Julie Quinlivan; and highly-respected health economist and former health department secretary Professor Stephen Duckett question these claims, stating publicly there was no evidence for them.”
Professor Robson said that compliance is something the AMA takes very seriously, and the association would work with the Medicare Integrity review that has also been announced today.
“The profession has nothing to hide and has a strong record of working to ensure that Medicare funding is directed to support patients, including on two recent legislative packages to improve the integrity of the Medicare system,” he said.