A shock new Health Services Union report claims doctors are treating Medicare as an “unlimited funding source”.
The AMA has hit back at a new report from the union representing aged care, hospital and community health services workers which has recycled the infamous $8 billion Medicare rorts figure… only this time, it’s grown to $10 billion.
The report, titled Billions Down The Drain, claims that Medicare reform is undermined by “self-serving organisations” and estimates the amount of money lost to fraud and non-compliance as being between $1.5 billion and $10 billion annually.
It also alleges that practices like “upcoding, overservicing, and rule-bending” are rife within certain specialties and that more than 93% of healthcare workers are afraid to report Medicare billing fraud in their workplace.
Too many practitioners, it said, “treat Medicare as an unlimited funding source”.
“Without stronger enforcement, AI-driven fraud and non-compliance detection, and a move away from self-regulation and fee-for-service models, Medicare remains vulnerable to exploitation, putting the very integrity of Australia’s healthcare system in jeopardy,” the report said.
General practice was placed under specific scrutiny, with the growing venture capital interest in the industry cited as potentially facilitating profit-driven care.
“It is clear the issue isn’t complexity, but a reluctance to manage administrative tasks, which are often seen as an imposition or ‘burden’,” the report said.
“A recent Royal Australian College of General Practitioners (RACGP) survey found ‘administrative burden’ to be a leading complaint and frustration of General Practice specialists (GPs) – we argue that’s just part of the profession.”
AMA president Dr Danielle McMullen called the $10 billion figure “baseless” and said it was disappointing to see the union “attempting to tarnish hardworking doctors”.
In late 2022, several mainstream media reports featured the claim that $8 billion in Medicare funding was going to waste each year through a combination of deliberate fraud, unintentional non-compliance and low-value care.
As an immediate response, the government commissioned Deloitte economist Dr Pradeep Philip to look into the claims.
Dr Philip concluded that it was likely that Medicare was only leaking $1.5 billion to $3 billion each year and that the significant parts of that leakage were down to noncompliance errors rather than premeditated fraud.
These figures broadly aligned with estimates from the Australian National Audit Office.
The HSU report claims that the government has persistently refused to quantify the full scale of Medicare leakage.
“The debated $10 billion estimate has not and cannot be definitively disproven, because there is no effective system to measure fraud and non-compliant billing in the first place,” it said.
“We strongly encourage the HSU to check their sources and invest more effort into looking after the interests of their members, rather than mounting unjustified attacks on hard working medical professionals who are focused on delivering the best possible care for their patients,” Dr McMullen said.
She also noted that HSU members played a critical role in the health system, which was valued by AMA members.
“While the HSU is intent on making outrageous claims, we will get on with the job of pursuing meaningful reforms, including advocating for a new National Health Reform Agreement to improve public hospital funding, and pushing for reforms to Medicare to bring it line with the 21st century,” Dr McMullen said.