Government to conduct independent review into Medicare while the AMA asserts the allegations are ‘shocking’

MedTech News: The government will commence an independent review into the integrity of Medicare and its compliance mechanisms after the joint 7:30, Sydney Morning Herald and The Age investigation uncovered allegations of ‘widespread rorting’ and inaccurate billing of the $28 billion scheme to the tune of $8 billion.

Health economist Dr Pradeep Philip has been appointed to conduct the independent review. As the Lead Partner at Deloitte Access Economics and a former Secretary of the Department of Health and Human Services in Victoria, Dr Philip has a long history working at the highest levels of public policy in Australia. 

A 2020 Australian National Audit Office (ANAO) report estimated the value of Medicare non-compliance at between $366 million and $2.2 billion a year. The independent Philip Review will assess the possible value of fraudulent, non-compliant or over servicing risks in Medicare and provide a methodology and evidence-based estimate of the likely value of non-compliance in Medicare. 

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Mark Butler MP, Minister for Health and Aged Care, said “Australians know that the overwhelming bulk of Australia’s doctors and health professionals are honest, hardworking and comply with Medicare rules. But they also understand that, after nine years of cuts and neglect, every dollar in Medicare is precious and must be spent directly on patient care.

“My Department has provided a report on the existing compliance efforts, along with a rundown of the various estimates on the scale of the problem from the ANAO and others. The report found no evidence of the $8 billion in Medicare fraud and inappropriate billing estimated by Dr Faux. I’ve asked Dr Philip to measure and report on the true extent of non-compliance in Medicare and identify fixes to protect the integrity of the system, for all who use it.” 

The Australian Medical Association (AMA) argued that the claims are an unjustified slur on the medical profession.

Steve Robson, President of the AMA, said “The more we’ve had the opportunity to look at these allegations, they just don’t stack up at all. I’m actually part of the group who sits in meetings with the health department. We analyse billing very, very carefully. Anything that looks odd at all is subject to further analysis. So it’s just a fantasy that this amount of rorting is going on. A total fantasy.

“There’s no doubt there are areas of Medicare that need improvement. And we’re actually working with the government, with the Health Minister and with the Health Department to try and refine things at the moment. But I’m aware of no evidence of this kind of rorting on an industrial scale. It’s just ridiculous, and it doesn’t help. And we agree that there needs to be improvement in Medicare, in the way the MBS works. It was brought in 35 years ago. But this sort of thing is not helpful to anybody and it just makes a profession that’s been totally smashed trying to protect the community for years want to give up. It’s really shocking.”

More than 500 million Medicare services are delivered each year totalling around $32 billion in government spending. After nine years of cuts and neglect, the review comes at a time of great pressure on the health system in Australia. 

Dr Philip will provide an interim report to the Government by 31 January 2023, with the final report to be submitted by 28 February 2023. 

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