Doctors are overwhelmingly doing the right thing by Medicare

22 September, 2009

Despite a few hysterical and misleading headlines in the papers, Medicare Australia’s National Compliance Program report provides compelling evidence that Australia’s doctors are overwhelmingly doing the right thing by Medicare.

AMA President, Dr Andrew Pesce, said the audit process has resulted in just four convictions against unspecified providers out of a total of 2,785 Medicare audits, and there is evidence of cooperation in cases where incorrect payments have been identified for recovery or correction.

“The report shows conclusively that the great majority of fraudulent Medicare claims are being made by members of the public,” Dr Pesce said.

“There are around 50,000 medical practitioners in Australia who provided more than
130 million consultations to patients over the audit period.

“The AMA supports the audit activity to ensure the integrity of the Medicare arrangements. It shows very strong compliance by doctors.

“We do not condone doctors ascribing items for services they have not provided. The report confirms that non-compliance by doctors is negligible.

“Meanwhile, as opposed to real fraud, Medicare Australia reports that claiming errors by 756 practitioners amounted to around $4.5 million.

“This only goes to show that Medicare is a complex system and should be simplified to
minimise inaccurate claims.

“The Medicare Compliance report backs this up with a clear statement that ‘the increasing number and range of items available through both the MBS and the PBS may result in misinterpretation or misuse of the schedules’,” Dr Pesce said.

Dr Pesce said it was a major concern that one of the most reported incidents of Medicare fraud involved a staff member of Medicare Australia.

“We can only hope that the audit process is as active in pursuit of and publicising the details of internal fraud as it is in pursuit and publicising members of the health professions,” Dr Pesce said.