MBS claims unjustified

Subject: Medicare Benefits Scheme

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ALEX EASTON:   Australia's public health system is struggling. It's been struggling for years. But it's an issue that's gone into overdrive since COVID. From the patient's side, it's sometimes dangerously long waiting lists for elective surgery or to get in to see a specialist or a GP. And it's the slow demise of bulk billing, as doctors have had to add gap charges to make up for the Medicare rebate's failure to keep up with their costs.

From the industry side, it's chronic staff shortages across the sector, and too few people going through the lengthy training processes needed to make up a lot of those shortages. Whichever way you slice it, it's a huge problem that is going to cost billions and billions of dollars to fix.

So reports yesterday that rorting by some healthcare professionals has been sucking around $8 billion a year, close to a third of Medicare's entire budget, might come as a bit of a shock. Reporting by the ABC, The Sydney Morning Herald and The Age yesterday quoted Medicare expert Dr Margaret Faux and GP and former head of Medicare watchdog the Professional Services Review, Dr Tony Webber, alleging some GPs were billing dead people, falsifying patient records to boost profits. And Dr Faux offered the $8 billion figure which I referred to before as just an estimate of the amount she believes is being stripped from this strange system. It's an estimate the Australian Medical Association quite firmly rejects.

Dr Maria Boulton is the President of the Australian Medical Association Queensland. Thanks for joining us, Dr Boulton. Why do you think that $8 billion figure is wrong?

DR MARIA BOULTON:   Good morning, Alex. It's really interesting, this $8 billion figure. We really don't know where it's comes from, and we couldn't actually see anything in the media reports yesterday to validate where that figure comes from. I would like to know, personally, where it's coming from. $8 billion sounds like a lot of money, but when you look at it in the context of the person making those allegations, there is also a vested conflict of interest, because that person is also in the business of Medicare billing and telling people how to bill. So it all needs to be taken into context.

But having said that, every cent of health funding is precious. Every taxpayer dollar is precious. So if there's any fraud going on, those people need to be dealt with, and there are mechanisms to do that. And that is why the government set up the Professional Services Review [PSR].

It is their job to ensure that if people are rorting the system, either Medicare or the PBS [Pharmaceutical Benefits Scheme], that they are held to account. But once again, this $8 billion figure, it makes no sense to us. We would like to know where it was pulled from. The person yesterday made it seem like there's this whole big industrial scale rorting going on.

And all that has done is that it's really, really disappointed every GP out there who's doing the right thing, at a time when they're fatigued, they're burnt out. We know that GPs continue to subsidise the care that their patients receive. We know that GPs subsidised at least half of the COVID vaccine rollout. GPs did 31 million COVID vaccines, and we know that the rebate that they received for that was not enough to cover costs. So we completely disagree with what's been insinuated.

ALEX EASTON:   I also couldn't see in the reporting, like the various reports yesterday, anything that explained how that $8 billion figure was reached. There are some specific points raised in the reporting. Things like billing dead people, at the more extreme end, or at the other end doctors billing Medicare for longer sessions than were actually delivered, to increase the rebate payment. Are these things happening?

DR MARIA BOULTON:   I suppose in any profession there will be bad apples. And I guess that's why the PSR was set up, to deal with people who are committing fraud. But our federal President actually had a chat to the current director of the PSR. And the current director of the PSR said that less than one in 1,000 GPs - or doctors, because Medicare covers rebates for patients to see not just GPs but other specialists, allied health as well - and the director said that less than one in 1,000 people are doing the wrong thing.

Whether that's by accident, because the Medicare system is difficult to navigate and it's really not fit for today's purposes, or whether that's on purpose, who knows. But that's what the PSR stated.

ALEX EASTON:   So that one in 1,000 figure includes mistaken overcharging, which as you say, the Medicare system is quite complicated. So you would think that that kind of mistake would be relatively easy to make.

DR MARIA BOULTON:   Yeah, it can be made. We saw during the COVID pandemic there were a lot of MBS items introduced, a lot were introduced, taken away, modified et cetera, at a time where GPs were so busy delivering care, mental health, COVID vaccines et cetera, that inadvertently mistakes may have been made. I know that, for me, it was almost a full-time job just keeping abreast of all the COVID vaccine changes, let alone all the Medicare item number changes. So there needs to be an allowance for that.

And that's what the PSR does, they go and investigate. If they're concerned, they'll go and investigate and see whether it was a mistake or whether there was actual fraud made. But it's really upsetting to see every doctor who's doing the right thing painted in the same light, because it's just not true.

ALEX EASTON:   Yeah. You would expect that it would be a tiny minority that would be deliberately doing the wrong thing. Have you heard much from your members about any feedback they've been getting from their patients, or the impact this reporting has had on them?

DR MARIA BOULTON:   Members are really upset over this. We've been exposed to a lot of things that are not true. So for example, I don't know if you remember our Deputy Premier stating that the reason why emergency departments were so busy was because GPs weren't seeing people with respiratory illness. Not true. We've never stopped. And this is just another thing in a long line of slurs that happen with GPs.

The beautiful thing is that we all have patients, everyone's at work today, seeing their patients, and patients have been extremely supportive. And I'm reading in some cases patients bringing flowers to their doctors, which doctors of course don't expect, but just providing lots of support for their doctors. Because patients realise how much doctors have done for them, how much the general practice staff have done for them. And it's not just GPs, but also our practice nurses, our receptionists, our emergency colleagues, all the hospital doctors out there. And patients do understand that and appreciate that.

ALEX EASTON:   All right. Dr Maria Boulton, thank you so much for chatting with us this morning.