Leakage is costing taxpayers a fortune each year due to crime, billing mistakes and an ineffective watchdog. A root-and-branch review is overdue.
Medicare fraud and billing errors by medical practitioners are costing taxpayers at least $7 billion a year, according to Dr Margaret Faux, a health regulation expert who has been administering Australian medical billing since Medicare began.
Her business – medical billing and coding processing group Synapse Medical Services, which advises doctors, hospitals and regulators – constantly finds problems in client billing practices.For example, a report released in 2020 for regulatory body SIRA found that the NSW government’s scandal-plagued workers compensation giant, icare, was paying a fortune to medical practitioners andKate Geraghty
The problem lies in the way Medicare was set up decades ago as an honour system where the doctor is assumed to bill correctly for the service provided.Armed with a patient’s name and date of birth, doctors can bulk bill anything and patients are often none the wiser.
Another case involved a GP who repaid $277,312 and was disqualified from Medicare for three months. The crime? Billing dead people for services in residential aged care facilities as well as poor record keeping. “The practitioner’s records were inadequate,” the PSR update said. It said the practitioner’s record-keeping practices would not allow another practitioner to take over care of patients.
It seems the system is such that if a dodgy practitioner is reviewed for fraud, the most likely outcome is refunding what shouldn’t have been taken in the first place and a suspension of the right to raid the MBS cookie jar for a finite period.
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