AMA says Medicare allegations a slur on the medical profession

ANDY PARK:           Introduced in 1984, it was a revolution in healthcare.

BOB HAWKE:           Every Australian, from newborn baby to Prime Minister, can share in the cheapest, simplest and fairest health insurance scheme Australia has ever had.

ANDY PARK:           Well, today, a joint 7:30, Sydney Morning Herald and The Age investigation has uncovered allegations of widespread rorting and inaccurate billing of the $28 billion scheme to the tune of $8 billion, that's according to one expert opinion. The report claims Medicare is easy to rort, and is almost impossible to detect fraud, incorrect payments and errors. And the Federal Health Minister, Mark Butler, has ordered his department to report on the existing compliance, audit and review programmes. Steve Robson is the Australian Medical Association's president. Steve, welcome to our RN Drive. The AMA argues that the claims are an unjustified slur on the medical profession. Are you suggesting that rorting isn't happening at all?

STEVE ROBSON:     Good afternoon, Andy. Look, I think they're not only an unjustified slur, they're just plain wrong. And the more we've had the opportunity to look at these allegations through the day; they just don't stack up at all. I'm actually part of the group who sits in meetings with the health department. We analyse billing very, very carefully. Anything that looks odd at all is subject to further analysis. So it's just a fantasy that this amount of rorting is going on. A total fantasy.

ANDY PARK:           Okay. A highly referenced, well-respected report from the former head of the Medicare watchdog, the Professional Services Review, Tony Webber in 2012 cited: the cost of misuse of the system is 3 billion a year. What steps has the AMA taken in the last ten years to address fraud and rorts?

STEVE ROBSON:     Well, I spoke to the current acting head of the Professional Services Review today and he said that's rubbish. So I think trying to get this sensationalist stuff from a decade ago is pretty useless information really. And what we're about today is saying, how can we actually strengthen Medicare? What can we do? There's no doubt there are areas of Medicare that need improvement. That's absolutely clear. And we're actually working with the government, with the health minister, with the health department, to try and refine things at the moment. But I'm aware of no evidence of this kind of rorting on an industrial scale. It's just ridiculous, and it doesn't help. And we agree that there needs to be improvement in Medicare, in the way the MBS works. It was brought in 35 years ago. But this sort of thing is not helpful to anybody and it just makes a profession that's been totally smashed trying to protect the community for years want to give up. It's really shocking.

ANDY PARK:           I put it to you that you say that there's no evidence of misuse. And look, we might be playing word games here, rorting misuse, let's call it waste. Maybe that is the problem in itself. Waste is estimated to consume, what, about 30 per cent of the health care budget. Dr Faux, who a lot of these claims comes from, her PhD into waste in Medicare estimates wastage within Medicare totals about 30 per cent. So is it inaccurate to apply that 30 per cent estimate to individual schemes or services, rather than the sort of health service as a whole?

STEVE ROBSON:     I think you have to look at those claims through the lens of the conflict of interest in somebody who's actually running a business around this. What we do is say, well, look, how can we tidy things up? And there's absolutely no doubt that some areas of Medicare at the moment need a tidy up. That's why we're part of the Strengthening Medicare taskforce. And one of the big problems we see, and we see it all the time, is that a patient will have some tests, somewhere they perhaps can't get in to see a GP. They see another GP who can't access the results, so they run the tests again. This is a really common thing and I see it through practise at the public hospital where I work. And commonly in the public hospital, we'll repeat tests because we can't get the results or for whatever reason. And having better digital technology, making sure that we don't have to spend a lot of money redoing things is important. I agree with you 100 per cent, but that's not rorting the system. That's actually an inefficiency in the system that everybody is working to try to resolve.

ANDY PARK:           I'm not so sure taxpayers really mind what word we use, rort or waste; it's still our money. Steve Robson is the AMA's Federal President. We're talking about these allegations of misuse, should we call them, of Medicare on RN Drive. Look, let me give you an example. Your speciality is gynaecology…

STEVE ROBSON:     Correct.

ANDY PARK:           …and I'm not suggesting that this is your practise, but are you saying that gynaecologists who operate on benign ovarian cysts are not wasting Medicare funding?

STEVE ROBSON:     Well, how do you know it's benign until you take it out? I see this time, and time, and time again. We have lesions, and it's a fantastic example, I commonly see people, and I say we could watch and wait. A proportion of people feel they're at risk and you ultimately don't know what an ovarian lesion is until it's out and under the microscope. And I've been surprised both ways. I'm not rorting the system there. I'm trying to help patients make a decision. And I think across the country, we're seeing the same thing happening, that there may be situations where - the great one is tests. An enormous amount of tests are done, they're often repeated for various reasons. All of these things aren’t - I mean, there's nothing really in it for a doctor to order more tests. It's hardly a rort. It's often just because they can't access results, and we're all about making the system better. We want that as much as anybody else does.

ANDY PARK:           A lot of the allegations are sort of pointed towards the speciality kind of medicines rather than GPs, or general practices, accessing the Medicare rebate. So what other areas are you concerned about in terms of- well, let's talk about cancer imaging is another known area for perhaps wasteful imaging. Are you saying that every image cancer specialists order is absolutely needed?

STEVE ROBSON:     Well, why would I say that? I mean, you're trying to put words in my mouth. What I'm saying is that often there is clinical uncertainty with things. Don't get me wrong, I'm not saying for one second that there are not people, here and there, doing tests on a monetary basis on which they make money…

ANDY PARK:           [Interrupts] And that is rorting and that is wrong.

STEVE ROBSON:     And I'm saying that this happens, but I spoke the Director of the Professional Services Review today, who said that represents 0.1 per cent of things. So that means one out of a thousand doctors; 999 of us actually doing our utmost to try to provide great care for patients. And I think it's just outrageous. These accusations that are out here. It's just incredible.

ANDY PARK:           Are you not concerned that the AMA doesn't have your own research on this sort of wastefulness? I mean, you're relying on- well, certainly I'm relying on Dr Faux's allegations and the Department of Health. What about your own estimates here? You don't have anything concrete?

STEVE ROBSON:     Well, I do have something concrete. I actually spoke to the head of this Department of Medicare today, someone I met with three times in person last week. And as I said, Andy, I commonly go to meetings where we look at data for billing, for services with a fine-toothed comb. And I can tell you that if we think that something is being rorted, we say let's make sure you investigate the people who are doing this, because it goes against the reputation of the profession. And we're as aware as anybody else that there are limited resources and we want great and good stewardship of the resources, and we're all about fixing systems. I'm not saying for one second that every single doctor in this country is a saint. Like other professions, that's not the case. But the best information we have is that about one in a thousand have practises that are of concern and go to further investigation, as they should. But the overwhelming focus of the profession is just providing great care, Andy.

ANDY PARK:           We're out of time. Steve Robson is the AMA's Federal President. Appreciate your time tonight.

STEVE ROBSON:     It's a real pleasure.