Minister sets the record straight about Govt Medicare audits

“Medicare pays out over $13 billion in taxpayers’ money annually – and that figure is growing by more than $1 billion each year,” Senator Ludwig said.

“The Rudd Government has a responsibility to ensure taxpayers funds are spent appropriately and correctly.”

“This initiative will result in savings of more than $148 million for taxpayers.”

“The proposed legislation does not provide Medicare Australia with open, unfettered access to patient records or sensitive personal information.”

“It will be up to the health professional to determine what documents or excerpts of the clinical record they wish to provide in order to demonstrate a Medicare claim was correct.”

“These excerpts will simply verify what is already known to Medicare Australia through the usual claiming process.”

“Under no circumstances will Medicare Australia staff be reviewing entire patient records – only a small number of specially trained Medicare staff will have access to excerpts received from health professionals to substantiate their MBS claims.”

Senator Ludwig said Medicare has a strong privacy record and is trusted by Australians.

“The Government and Medicare Australia have been working with the Privacy Commissioner to ensure the legislation includes appropriate safeguards to protect individual privacy and maintain confidence in our health system,” he said.

“This is not an attack on the medical profession. With this legislation, the Government is seeking to close a loophole that allows any medical provider to refuse requests for information for the purposes of a Medicare audit.”

“On average, 20 per cent of medical providers don’t cooperate with audits and we want to know why.”

“This initiative is vital to protect the integrity of the Medicare scheme by ensuring proper checks and balances of the system.”

“When there are concerns or anomalies with a doctor’s billing, it is highly appropriate for that doctor to be asked to demonstrate that their claims were legitimate.”

Last year 213 doctors were identified as claiming $3.48 million incorrectly and over $250 million was saved from the MBS and PBS through all Medicare Australia compliance activities.

"Where people have access to Australian Government payments, a reasonable level of compliance activity needs to occur to protect taxpayer money," Senator Ludwig added.

"This legislation simply places the same expectation on health professionals that the rest of us normally face when claiming a tax deduction or receiving a subsidy—the provision of information to show a particular activity actually took place.”

The proposed amendments are contained in the exposure draft of the Health Insurance Amendment (Compliance) Bill 2009.

Senator Ludwig referred the proposed legislation to the Senate Community Affairs Committee.

The Committee has received submissions and held a public hearing, and is due to hand down its final report.