Medicare fraud debacle distracts from inequity & under- resourcing

After 20+ articles published over the past 2 weeks, we have all heard a lot about Medicare fraud. It seems increasingly unlikely that the Dr Margaret Faux’s $8bn estimate will be substantiated- the most comprehensive investigation thus far has debunked the figure, with the authors finding that there is: 

‘no evidence in her PhD to support the $8 billion estimate of fraud. We think that number is likely to be much lower.’ 

Even if the number is debunked, the damage is done. Sensationalist reporting around ‘fraudulent doctors’ demoralises our burnt-out medical profession in both public and private sectors and obscures the real issues. 

Our members are working in an untenable, underfunded and constantly short-staffed hospital system. In addition to the pressures of delivering safe patient care in these challenging conditions, public hospital doctors are obligated to navigate an overly complex Medicare billing system with very little support.  

We absolutely reject the notion that public hospital doctors systematically defraud Medicare. 

However there is no doubt that the dual funding of healthcare across Australia creates inefficiencies and errors. Private Practice arrangements for public hospital doctors vary significantly from state to state and are extremely complex. 

Commonly, patient billing is controlled by the employer of our members, and specialists rely on the administrative services directly controlled by hospitals and funded by their facility fees. Given the complexity of billings, administrative and processing errors may lead to false statements being made. In some cases, doctors have limited ability to access and review billings made on their behalf.  

We encourage all our members to regularly oversight their billing records, but there can be challenges to doing so. In some hospitals administrative systems are lax, outdated, under-resourced and there is high turnover of administrative staff. These factors increase the likelihood of errors being made for which doctors are liable.  

Current Medicare arrangements also create inequity for patients in public hospitals.  

For public hospitals, who are state funded, not only Medicare rules apply -but an additional set of rules in the National Health Reform Agreement, which systematically undermines Medicare funding in public hospital outpatient clinics.  

Public hospital’s outpatient clinics are often the only free medical services patients can access. The National Health Reform Agreement between the states and federal government create a two-tier system between patients who can afford medical care in the private health care sector and those patients who cannot.

One example is the aftercare following an admission to a public hospital. The aftercare of a private patient in the public hospital will attract a taxpayer funded Medicare rebate, whereas the after care of a public patients in the same public hospital does not attract Medicare funding. This ultimately will lead to a higher out of pocket expense or no aftercare for patients who cannot afford private health insurance.  

It is clear we need an overhaul of the Medicare billings system that is sustainable, and simpler for doctors and patients to navigate. 

We also need state and federal Governments to put big picture health reform on the agenda, and work in partnership to deliver more equitable access to publicly funded healthcare. 

Our analysis of the Federal Budget (here ) shows that we still have a long way to go to achieve that.