Medicare fraud allegations slammed

The Australian Medical Association (AMA) has said it is “extraordinarily disappointed at the allegations today in the media suggesting that up to $8bn is being defrauded each year from Medicare by health professionals including doctors”.

These claims are an unjustified slur on the medical profession, with the vast majority of doctors doing the right thing by their patients and by Medicare rules, said the AMA in a statement.

“The AMA meets regularly with the Department of Health, which has sophisticated analytical tools, and understands that there is no evidence of the widespread fraud suggested in today’s media.

“The Department of Health has extensive data at its disposal and the AMA believes that this should guide Medicare compliance activities as opposed to the anecdotal evidence of a small number of individuals.

“Where evidence of fraud is found, the AMA fully supports efforts to stamp this out including referral to the Professional Services Review when required,” the Association said in a statement.

AMA President Professor Steve Robson said Australia’s doctors have worked incredibly hard through COVID — treating Australians during lockdown, rolling out the nation’s vaccine efforts, putting themselves at risk every day to treat COVID patients on the front line — so the coverage is as appalling as it is inaccurate.

“The vast majority of doctors do the right thing, and are working hard for their patients under tremendous pressure within the system.

“The AMA works closely with the Department of Health on compliance and we have never seen any concerns or numbers that would support the figures reported today.

“We do not tolerate fraud and examples of fraud should be tackled and stamped out — but the figures reported today are grossly inflated.”

RACGP President Adj. Professor Karen Price said it is “extremely disappointing that such sensationalist accusations have been levelled at the medical profession, including general practitioners — the vast majority of GPs are doing the right thing and deserve the community’s respect”.

“The assertions made in the media are based on limited data and loud opinions.

“The real problem with the Medicare item number system is that it is far too complex, there are over 5700 different item numbers, many with vastly different rules and requirements, and this gives rise to innocent mistakes. Even the guidance on correct use of MBS items can be ambiguous at best, and contradictory at worst.

“Margaret Faux’s research on Medicare has been cited in recent media reports. However, most stories have incorrectly implied non-compliance is due to deliberate abuse, when in fact Faux’s research found the principal cause is the complexity of the system and margin for mistakes.

“Let me be clear — any misuse of public funds is abhorrent, and anyone who rorts the system should be prosecuted, and I would welcome the government’s investigation into this matter.”

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