Compliance review vindicates doctors, dismissing claims of widespread rorting
An independent review into Medicare compliance has found no evidence of the $8 billion fraud alleged by the media last year, instead finding Medicare compliance issues are overwhelmingly caused by complexity of the system, confirming claims about Medicare fraud were vastly inflated and unsubstantiated.
AMA Vice President, Dr Danielle McMullen, said this week’s release of an independent report into Medicare integrity and compliance had found the overwhelming majority of doctors had done the right thing in providing high-quality care to their patients and had protected precious taxpayer Medicare dollars.
She was responding to the release of the Independent Review of Medicare Integrity and Compliance, which was commissioned by Health Minister Mark Butler following media allegations of rorting of Medicare.
The Review found no evidence of the $8 billion fraud quoted in Nine newspapers and the ABC’s 7.30 Report last year.
The report found Medicare Benefits Schedule (MBS) compliance issues were overwhelmingly caused by complexity of the system.
Dr McMullen in an interview with the ABC’s 7.30 Report said, “The unfounded claims of $8 billion of fraud gave the medical profession a huge blow. They felt like they had been hit by a bus.
“But this report vindicates their hard work and shows that the overwhelming majority of doctors are doing the right thing and that our Medicare system is being held together by the altruism and goodwill of the medical professions working in it.
“What it does say is that there is the potential for fraud, that our Medicare system and the billing systems behind it are not keeping pace with providing modern medical care and that there are gaps in the system.
“But what the report also says that despite those gaps the rates of intentional fraud are very low and the vast majority is actually due to that complexity of Medicare and the difficulties of matching best practice medical care with a complex MBS with over 6000 items.”
The Review found estimated the potential cost to Australian taxpayers of Medicare leakages was $1.5 to $3 billion a year with a significant part stemming from non-compliance errors rather that premeditated fraud.
The Review’s release coincided with University of Sydney analysis that found doctors were significantly more likely to undercharge than overcharge Medicare. It says underbilling is saving the health system more than $350 million in just one year.
AMA President Professor Steve Robson said the AMA would examine the Review’s recommendations more closely and was willing to provide advice to the Government on how to move forward.
“We will be working to ensure that patients are better supported to receive high quality, accessible, affordable care and that their doctors are not forced to spend more time on red tape as a result of the review’s recommendations.”
