Her research said the waste came from medical practitioners making mistakes or charging for services that weren’t necessary or didn’t happen,with flaws in the system making it easy to rort and almost impossible to detect fraud,incorrect payments and errors.
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The claims were vigorously disputed by doctors groups including the Royal Australian College of GPs (RACGP) and the AMA,with the association’s president Steve Robson describing them as staggering in their inaccuracy and an unjustified slur on the medical profession.
On Monday,Nicole Higgins from the RACGP issued a press release,based on early briefings of the review,saying doctors had been “slandered by baseless claims of ‘rorting’ for no good reason”.
“We have been vindicated and we await an apology,” she said.
Philip said most Medicare wastage stemmed from non-compliance errors rather than premeditated fraud and acknowledged that doctors had been offended by the allegations of intentional rorting.
But his report said there were structural flaws in Medicare and while it was difficult to determine precise levels of waste due to lack of available data,billions of dollars were leaking from the system each year.
“On a conservative definition of non-compliance and fraud,it is entirely feasible the value of non-compliance could exist in the range of $1.5 billion to $3 billion,” he said.
“This comes with a significant caveat,in that there is real potential for the problem to scale to the order of magnitude in Dr Faux’s analysis[$8 billion],should effective controls,systems and education not be put in place.”
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He also credited Faux for “shining a light on the key issue of trust in our health system”.
Philip argued the dollar figure should not be the focus of debate and said there was no room for complacency.
“The main lesson to learn from this review is that we must focus on the structural issues and controls in the system,to build trust in Medicare,” he said.
“The current system is overly fragmented,disjointed,and lacking in contemporary tools to detect and address non-compliance and fraud.”
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“Stamping out fraud and reducing non-compliance must be the focus of system reform.”
Philip also called on state governments to investigate the opaque billing arrangements of public hospitals amid claims by medical specialists that they have little or no visibility over what is billed in their name.
Faux said many of Philip’s recommendations were aligned with her PhD. “We’re essentially saying the same thing:regulation,education and digital reform are required urgently,and I agree with him on that,” she said.
“What I disagree with is his estimate ... my 30 per cent estimate has always been on three things:fraud,overservicing and errors. It was never focused on GPs,it is system-wide.”
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Butler said several reviews over many years had identified that billions were being lost through Medicare each year.
He said the government was considering Philip’s recommendations and working with stakeholders to develop a response.
“Australians know that the overwhelming majority of our doctors and health professionals are honest,hardworking and comply with Medicare rules,” he said.
“But they also understand that,at a time of great pressure on household and government budgets,every dollar in Medicare is precious and must be spent directly on patient care.”