Faux’s estimate of 30 per cent annual leakage from Medicare is in line with Kathryn Flynn’s PhD published in 2004,which noted some believed fraud and inappropriate practices could be as high as 25 per cent.
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This week’s revelations prompted Health Minister Mark Butler to announce a departmental inquiry into the matter.
But there are growing calls for an independent review that isn’t influenced by vested interests and lobby groups.
A specialist surgeon in Victoria with more than 30 years of practice,both in public and private,said rorting and the ineptitude of governmental response has been the norm for decades.
The surgeon,who asked for anonymity for fear of backlash from his colleagues,said the entire Medicare system needed an overhaul,but he warned that previous attempts had been “laughable token gestures”.
He said there were two types of Medicare fraud:charging for services never performed,such as care for dead people,but the more prevalent costly fraud occurred where services were rendered for no valid medical indication.
“Some of these instances may be due to ignorance or poor medical practice,but the vast majority are pernicious in provenance – a chance for the doctor to make more money,” he said.
He included in the latter group commonplace diagnostic procedures,surgical interventions and procedures including as gastroscopy and colonoscopy,joint arthroscopy,cardiac angiography and radiological procedures.
Former deputy chief medical officer of Australia and now clinical associate professor Nick Coatsworth and PhD scholar with the Menzies Centre for Health Governance at ANU wrote in anopinion piece this week that Medicare is in crisis and Butler’s review was “an easy way out that will do little to save Medicare”.
He said one of the biggest costs to the health industry is low-value care,which provides little or no benefit,may cause patient harm,or yields marginal benefits at a disproportionately high cost.
A 35-year-old who contacted this masthead warned about rorting going on in ADHD diagnosis for adults. “I was diagnosed with ADHD last year at 34-years-old;I have never been exposed to such blatant Medicare rorting in my life,” the email said.
“My Medicare records show multiple bulk-billed appointments when I paid very high out-of-pocket fees for psychiatry services for ADHD,including bulk-billed items for single appointments. I have been pushed onto the wrong appointment type so that the practice can claim hundreds of dollars more from Medicare,” the email said.
Urology,cosmetic surgery,dermatology,cardiology are other areas that have been accused of inappropriate billing.
But as nurse-turned-cosmetic surgery whistleblower Justin Nixon said after revealing questionable Medicare billing practises at theLanzer cosmetic surgery clinics:“As a healthcare worker,you’re routinely facing shortages because there’s not enough money to go around. There’s often ramping,hospital cuts but certainly,there is a huge pool of money. But the problem is,is that you have avaricious predators diving into the public purse and then eventually there’s not enough money to go around. So,that’s why it matters.”
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