FISHER, Dr Matthew, Chief Executive Officer, Australian Dental Association (New South Wales)

PINCHBACK, Dr Jane, Peer Adviser, Australian Dental Association (New South Wales)

RUPASINGHE, Mr Bernard, Policy Officer, Australian Dental Association (New South Wales)

SINCLAIR, Dr Mark, President, Australian Dental Association (New South Wales)

[10:02]

CHAIR: Welcome. Information on parliamentary privilege and the protection of witnesses and evidence has been provided to you. The committee has your submission. I now invite you to make a short opening statement, and at the conclusion of your remarks I will invite members of the committee to put questions. We ask for a short opening statement because, as you witnessed, there are a lot of questions that can be asked. So if you could keep your remarks short, that would be appreciated.

Dr Sinclair : Thank you, Chair. I am conscious of the statement you made to my colleague, so I will preface this by an abridged version of my opening statement.

CHAIR: Thank you.

Dr Sinclair : I am a registered dentist. I am in general practice in Bathurst in New South Wales. For more than two years now an internal audit program established by Medicare Australia has focused on auditing compliance by dentists who have participated in the Chronic Disease Dental Scheme. They have been asked to repay this money primarily for failing to provide patients with a written treatment plan and quotation before commencing treatment, including the provision of emergency dental care to a patient, and for not providing the referring doctor with a copy of the patient's treatment plan. Some have also pre-billed for services, a common practice for dentists but which is prohibited by Medicare Australia. ADA New South Wales believe close to 90 per cent of all dentists who participate in the Chronic Disease Dental Scheme would be deemed to be non-compliant under the existing audit regime based on the experience of peer advisers engaged by New South Wales ADA and who work in our member advisory service. We strongly believe that the reason so many dental practitioners would be deemed non-compliant is largely that the administrative requirements of this scheme were either poorly communicated to dentists or in some cases not communicated at all.

Despite many claims to the contrary by the Department of Health and Ageing and the Department of Human Services, the education program for dentists and other dental practitioners relating to this scheme was largely nonexistent. In addition, there was little or no consultation with the dental profession regarding the construct of the scheme or its ongoing operation. This has been a significant factor contributing to high levels of noncompliance by dentists. As a result, many of the requirements of the scheme are illogical or impractical and often fly in the face of standard dental treatment protocols. In many cases, the requirements of this scheme directly conflict with the duty of care dentists owe to their patient. Despite repeated assertions by Medicare that auditors were prepared to be flexible in individual cases, our experience suggests quite markedly otherwise. No flexibility or leniency has been shown where section 10 requirements of the Health Insurance (Dental Services) Determination 2007 are not met.

The ADA New South Wales strongly suspects both the Department of Human Services and the Department of Health and Ageing assumed the Chronic Disease Dental Scheme would close relatively early in its existence, which helps explain the initial failure to consult with and then educate dentists about the CDDS requirements. It is also clear that both organisations are themselves unclear about many of the parameters of this scheme, about dentistry in general and about the way in which the dental profession operates in practice. Dentists have been unfairly and very publicly accused of rorting this scheme for financial benefit when most noncompliance stems from failure to complete required paperwork prior to attending to a patient's dental needs.

The ADA New South Wales endorses this bill because it seeks to redress an injustice. Dentists should not be penalised if they have provided appropriate dental treatment in a timely fashion to patients with chronic disease simply because they failed to comply with paperwork requirements they misunderstood or even were unaware of. This profession would never assert it is immune from scrutiny, audit or review, nor will it ever condone fraudulent activities against the crown or defective and inappropriate delivery of care. This audit process has highlighted the poor construct and implementation of the law that was developed with little or no consultation with the profession and would manifestly fail the test applied by the common man of basic fairness in its most simple application.

Senator BUSHBY: You noted that greater than 70 per cent of dentists who have been audited were non-compliant and you estimate that 90 per cent of those who participate in the CDDS are non-compliant. Do you think that has improved since the focus on what the requirements are of the scheme under the section 10 determination and what they are in the last 12 to 18 months?

Dr Sinclair : I can only refer to my colleague's earlier comments—that I would hope it has dramatically improved. If the question from the senator is whether we have tested that in the last three months, I cannot give you that evidence, but it has been the bane of our existence that almost on a monthly basis we have gone to extraordinary lengths to highlight in various public forums and through a variety of media communicating with our members the importance of the compliance code with this framework.

Dr Fisher : In our meetings with Medicare we have also attempted to look at the practical application. We have asked a series of questions to enable us to give succinct advice to members about compliance. Certainly we refer to our letters of exchange in our submission, and it would be fair to say that there are still many cases where we are not able to get a concrete answer back to enable our members to comply with the law as it stands.

That then brings the issue for us that, as much as we are aiming to educate our members about compliance at all the different levels—not just the treatment plan, the informed consent and the exchange—the further we go into this scheme, the harder it is for members to comply, as Dr Sinclair said, with regard to the duty of care as well. We are seeking those answers from Medicare on a regular basis.

Senator BUSHBY: Because of the conflict between what dentists consider a patient's best care and the strict requirements?

Dr Fisher : I think it comes back to the rules of the scheme as they stand to enable a dentist in practice to apply that under a care pathway.

Senator BUSHBY: It might have been in your submission, but an example of that might be a patient having an initial examination, identifying some immediate and urgent need for dental care at that particular point but not being able to deliver that under the scheme unless a care plan was first sent to the GP and provided to the patient. Then conflicting advice comes from Medicare Australia that, if you actually provided it on the same day, it probably would not be compliant.

Dr Fisher : Correct.

Dr Sinclair : Further to your point: anecdotally, we can report cases where ambulatory patients in pain have been transported 300 kilometres for treatment and been advised that, because of paperwork requirements, their pain cannot be treated on that day.

Senator BUSHBY: With the consequence, presumably, that they get sent home and have to come back later, and in the meantime they continue to wear the pain.

Dr Sinclair : Correct. In fact, if you carry out the treatment, you are in breach of the determination.

Mr Rupasinghe : Having said that, though, it is probably pertinent to point out that many of our members would provide that treatment and thereby put themselves in a position where they were non-compliant. I do not think you would find many dentists who would actually say, 'I'm not going to provide you with emergency or acute care until I've done paperwork requirements.'

Senator BUSHBY: Would your dentist now make a claim for it if they were aware they were non-compliant? Presumably they would not.

Dr Sinclair : The question is?

Senator BUSHBY: In the situation that Mr Rupasinghe just posed—if you were faced with an ambulatory patient who needed urgent care and travelled 300 kilometres to get there—ultimately most of your members would actually deliver that care.

Dr Sinclair : I think today we would fax through immediately the requirements to the referring GP. Given the constraints or logistical issues associated with the delivery of that patient, you would formulate the treatment plan almost instantaneously.

Senator BUSHBY: So you would make whatever attempts you could to try to be compliant even though it is probably still a bit of a grey area whether that rectifies it.

Dr Sinclair : Correct.

Senator BUSHBY: So even today there are still issues in terms of how that is applied. This bill is designed to address the non-compliance issues that pre-date today and the approach that the government, through its departments, is taking to address noncompliance and the consequences of that. The government's position is that dentists were adequately informed and educated of the processes and should have known what they were supposed to do. The actual evidence we just discussed, though—the 70 per cent noncompliance—suggests that there was a problem with that, and this bill is designed to make it clear that the government has the discretion to be lenient on dentists who are non-compliant with that section.

I am interested in the education side of it. Your submission does a very good job of going through what the government alleges were the key areas that led to the education of dentists so that they should have known. Would you mind taking us through those six key documents that the government suggests comprised a full educative process?

Dr Pinchback : I would like to make some comments in relation to the auditing process. I think it became—

Senator BUSHBY: Yes, but what I am keen to do is this. The government through its departments alleges that it communicated fully with dentists so that dentists should have known exactly what they were supposed to do, particularly in terms of the section 10 determination, and I am—

Dr Fisher : I will pick this up. We have gone through a list of Commonwealth communications to dentists related to the CDDS from October 2007, which commenced in October 2007 with a letter from the then health minister advising of the introduction of a new scheme. Then, moving to June 2008, there was a fact sheet to dentists issued. Sorry, I will go back to October 2007, where the MBS schedule was issued on the Medicare website.

Senator BUSHBY: What I would like you to do is to point out basically your argument as to why that does not really constitute a document which would have contributed to a full educative process.

Dr Fisher : I think it comes down to the sense of what is required to be a full educative program. Certainly just issuing information on a website does not achieve that. We have certainly been in correspondence with Medicare since 2008, asking them to be more fulsome in their education of the profession. I think this probably pertains to the uncertainty of the scheme that was occurring in that time, with the change in government then, with the view of closing, so this is where we do have correspondence with Medicare Australia. Even back in September 2008, we requested articles for them to publish because we were aware that it was going to become an increasing issue. Those requests were never fulfilled. In a response to us in September 2008, Medicare wrote back: 'Cannot provide article based on the Commonwealth's dental arrangements, given that they are under a cloud in the Senate.'

Senator BUSHBY: So you were seeking further information from the government in order to better inform your members of how the scheme worked altogether, including the compliance aspects, and they were coming back and saying, 'No, we cannot do, because it's going to be closed down'?

Dr Fisher : Correct.

Senator BUSHBY: There are other examples that the government are relying on as part of their education process, including a letter from 3 March 2008 which comprised no more than a notice to dentists and dental specialists informing them that the government intended to discontinue the CDDS. That letter is included in a list of documents that Medicare Australia says forms part of the educative process, and all it does is tell them that they are going to close down the CDDS.

Dr Fisher : Certainly our experience of then being in contact with Medicare supported that view that there was the uncertainty, and that made it very difficult for us to provide conclusive direction back to the members with regard to compliance.

Mr Rupasinghe : Senator, if I could just address that: those six documents that we outline in our submission were specifically referred to on numerous occasions in various previous Senate committee hearings by both the Department of Health and Ageing and the Department of Human Services, where they have been asked a question about what education was provided—what correspondence was sent to dentists or dental practitioners to alert them to the requirements of the scheme? There is constant reference to six documents.

Senator BUSHBY: And the best they can come up with in those six documents is letters that say they are closing it down and nothing more.

Mr Rupasinghe : If these are the best that they can come up with, two of them really only say, 'We're going to close this scheme.' One of them talks more about the Medicare Teen Dental Plan. Really the only one that we have identified as being of any substance was very early on, the second occasion, on 17 October, when the Medicare Benefits Schedule was sent to dentists. We note the fact that at the time there were probably 13,000 registered dentists in Australia but according to Medicare they only sent it to 9,000 people. That was on the basis of a member list apparently provided to them by our federal body and also the Dental Prosthetists Association. Given that all dentists and dental prosthetists were registered in this country at the time, it is astounding that about a quarter to a third of all those practitioners did not receive it. I do not see how it was incumbent upon us to provide Medicare with that information.

Senator BUSHBY: I think that is a point well made. To what extent does that 17 October 2007 schedule make it emphatically clear that dentists must comply with the section 10 determination or they will not be paid?

Mr Rupasinghe : We say it does not and Jane would probably be the best person to answer that.

Dr Pinchback : I think the wording in the schedule is vague. It refers to a requirement for there to be information provided back to patients in the form of a treatment plant and a summary to the GP. The timing is not specific. There is no indication that it is imperative that it is done prior to the commencement of treatment.

Senator BUSHBY: How big a document is it?

Dr Pinchback : It is about 36 pages.

Dr Fisher : It is 65 pages.

Senator BUSHBY: So it is a large document. How much of that document would actually focus on section 10 determination requirements?

Dr Pinchback : It is one paragraph on one page.

Senator BUSHBY: So it would be quite easily missed. Is there anything in the document that refers to the importance of compliance with that section and the consequences that might flow?

Dr Sinclair : Certainly not from my understanding.

Mr Rupasinghe : From our point of view, as an association, we did not become aware of section 10 or the importance of it until almost Christmas 2009, which means our members would not have become aware of it until well into 2010.

Senator BUSHBY: According to your submission, the detailed letter from Medicare to dental practitioners of 29 April 2011 was the first time you recall Medicare Australia writing to dentists and specifying the explicit purpose underpinning the section 10 requirements?

Mr Rupasinghe : That is correct. But having said that, again, it was only 2½ pages. It was sent 42 months after the scheme commenced and it was what we would call a very short letter. It was the most comprehensive that had been sent but it was still a very short letter sent to dentists.

Senator BUSHBY: Given the level of communication between Medicare Australia, the Department of Health and Ageing, the Department of Human Services, the government and dentists, how could dentists have worked out their obligations under the section 10 requirements and what they had to do? Do you think it was possible?

Dr Pinchback : When we look at the history of the audits it becomes apparent that the department, in its first wave of audits, which occurred in 2009, was looking for evidence of double billing and fleshing out the accounts—

Senator BUSHBY: The stuff they should be looking for?

Dr Pinchback : I guess, yes. I do not think they found that. In that first audit wave there were 21 practitioners. Around about six months later—and this coincides the establishment of the chronic disease task force—those same 21 practitioners were audited a second time but the format of the audits were different. So in November 2009, the auditors contacted the dentists, went into their practice, had a look to see what they were doing, provided them with information and left. In the middle of 2010 they appeared to have worked out what it was they were going to have a look at and it appeared to be section 10.

The second audit was a paperwork audit. The dentists were sent a letter which indicated a two-year period. They were provided with a schedule of 20 patients that they had seen during the two-year period and were asked a series of questions which related to section 10 compliance. The questions included: was a valid referral from a provider provided prior to the beginning of treatment? Was a written quote provided to the patient prior to the course of treatment? Was a written treatment plan provided to the patient prior to the course of treatment? Was a treatment plan or summary provided to the referring GP prior to the course of treatment?

The practitioners could answer the schedule by putting a yes or no in a box, signing it, sending it off and providing supporting documentation.

We have got a report of an audit here dated November 2010. In that report there is a statement from the auditors where it says:

... awaiting directions from the CDDS Taskforce on final item number exclusions from the schedule other than 85011-85013 and 85022 - 85039.

That is examination and X-rays. We finally became aware, through a letter which came back in one of our audits—and this was in late 2011—of the view that the department had formed about what they were going to accept as constituting valid treatment at the initial examination prior to the provision of paperwork and subsequent treatment. In this document they refer to items A1, B1 and C1 in schedule 1 of the dental services determination. We went back to that document and referenced those item numbers and were subsequently able to provide our members with the checklist exactly outlining what item numbers in the department's view they could validly perform at that first appointment prior to providing section 10 documents.

Senator BUSHBY: So you needed to piece it all together along those lines before you could actually have any degree of certainty and, even as we discussed, there still is not certainty on all aspects of it at this point?

Mr Rupasinghe : This checklist was put together in—

Dr Pinchback : February 2012.

Mr Rupasinghe : three and a half years after the scheme commenced and we have only just realised what our members need to do to be compliant with the scheme.

Senator BUSHBY: Okay. Essentially, you have been trying hard to service your members and you have been trying hard to keep them up to date in terms of what they need to do to be compliant with all schemes, but particularly this one. You have had difficulty doing that and you are not surprised at the high level of noncompliance, but you are surprised at the approach that the departments are taking in terms of what they do as a consequence?

Mr Rupasinghe : Absolutely.

Dr Pinchback : If we access our member survey where we asked practitioners what they would routinely do at an initial consultation, 86 per cent of them indicated that they would attend to the patient's presenting complaint, and that would automatically render them non-compliant in an audit situation.

Senator BUSHBY: So there is a lack of understanding of how dentistry works as well.

Senator DI NATALE: I think that Senator Bushby has actually addressed most of my questions so I will be brief. When was the first you heard about the chronic disease scheme? Were you involved in the design of the scheme at any point? When was the first time you made aware of the scheme?

Dr Sinclair : As a professional body or as a personal practitioner?

Senator DI NATALE: Perhaps both, but given your position, probably the same applies—

Dr Sinclair : At the time at which the scheme was commenced, the May 2007 budget when there was a public acknowledgement that the scheme existed, anecdotally and off the top of my head, in a clinical sense I would not think that I had any participation in the scheme personally until late 2008.

Senator DI NATALE: So you really only heard about it as a professional body once the design of the scheme was essentially finalised?

Dr Sinclair : Correct.

Senator DI NATALE: Do you think it strange that one of the most important changes to your profession in terms of the way services are provided, had you essentially excluded from the discussion around the design of the scheme?

Dr Sinclair : I think that it is an extraordinary oversight for a professional body that is going to be responsible for the implementation of this scheme for there to be virtually no discussion—

Senator DI NATALE: Virtually none, or none?

Dr Sinclair : None, to the best of my knowledge—none.

Senator DI NATALE: What is your explanation for that?

Dr Sinclair : As my colleagues noted in their previous submission, there was obviously some degree of political imperative at the time. As time has gone on, the issue of the delivery of a universal, publicly accessible dental scheme has generated more public interest and public momentum. Looking back, quite frankly I think it was seen as some form of political imperative that suited the time and nothing more than that. We have had some exposure since with the teen dental program. Those sorts of programs are still in existence and are still being implemented on a daily basis.

Senator DI NATALE: As a professional body did you have an involvement in the design of the teen dental program, at least?

Dr Sinclair : To the best of my knowledge, no.

Senator DI NATALE: So again it was another scheme introduced without consultation with the profession?

Dr Sinclair : Yes.

Senator DI NATALE: I asked a question of the federal body, which I will now ask you. Once you were made aware of the scheme and the design was obviously finalised, what involvement did the New South Wales branch have in ensuring that its members were informed about how the scheme would operate? What sorts of billing requirements were necessary for people to render services under the scheme?

Dr Sinclair : There is a whole chronology of documents, I believe, tendered in our submission with regard to the dialogue between us as an association and our members. As I said earlier, it occurred on an almost monthly basis, highlighting our concerns about the scheme and the need for section 10 compliance.

Senator DI NATALE: I am talking about prior to the issue of an awareness that section 10 compliance was necessary. I am talking prior to that date. Were you involved as a professional body in educating people about the scheme, informing them about what was necessary in terms of compliance and so on?

Dr Sinclair : In terms of that core set of criteria, I think our involvement was to some degree limited because we were not manifestly aware that this was a make-or-break component of the compliance schedule. Certainly at the time that the framework was being implemented—and you could plead ignorance in respect of this—we were to some degree unaware of the potential ramifications of failure to comply.

Mr Rupasinghe : I think it would be fair to say that the federal branch, and I can speak for New South Wales, and I am sure most of the other state and territory branches as well would have passed on to our membership the information about the scheme that was made available to us. But that information was just so limited in its content that it turned out to be practically worthless.

Senator DI NATALE: I understand how difficult it is to communicate with individual practitioners, given the nature of the work. Is the only way to make direct contact with your members through a national database? Would the department have access to the details of all registered practitioners and, therefore, would they be able to make direct contact independently of you?

Dr Fisher : Certainly. As you would understand, national regulation consolidated a database, but even prior to that there was the ability for the dental boards who hold the register of practitioners to exchange information, even in the absence of the national scheme. So, yes that there was.

Senator DI NATALE: So, again, why would the department choose to use the professional body?

Mr Rupasinghe : The answer to that is that you would have to ask them. It is bemusing. It is surprising.

Senator DI NATALE: They could have sent correspondence to every single registered dental practice titioner in the country, informing them about this scheme. Yet they chose to direct that information through you, knowing that not all dentists are members of the ADA and knowing that there was a good chance that your database would be less current than the Register of Dental Practitioners.

Dr Fisher : Correct.

Senator DI NATALE: Do you have any explanation for why they chose to go down that road?

Dr Sinclair : I think that it was a discretionary bureaucratic decision.

Dr Fisher : Just to give you a sense of the extent of how we have tried to educate our members. It is done through a whole range of modes. We do podcasts. Dr Sinclair had a discussion with the state president of the AMA to look at it from both a medicine and a dental perspective. Since we have really been engaged in this process, we have attempted to educate our members very clearly through personal visits, when we go out around the geography of New South Wales and the ACT, of our constant writings, our email blasts and our podcast—a whole range of things go out.

I go back to the point that we are in constant dialogue with Medicare to get clarity to the process so we can continue to advise our members on the way that they can comply. The difficulty for us is there is still uncertainty in these areas. To be conclusive in what we do, we put forward material that we are planning to publish to aim to get sign-off, so we are correct with what we do. We provide that. There are some difficulties in reaching an agreement because it starts to go into the chasm between policy and implementation. That is where I think our members are now being stuck: between the policy and the implementation.

Senator DI NATALE: It is not medicine, but not all dental professionals are members of the association. Even with those who are I imagine there are varying degrees of engagement with their professional body. I am sure some of them will engage very much and be very keen to watch and listen to the material you will produce, but I imagine that that is still only a proportion. I imagine less than 50 per cent of your members actively engage in that way. There needs to be an alternative way to reach those other members. Given that the department has direct access to those members through its database, there is a role for the department to ensure that it is engaging with those people who may not necessarily have a relationship with their professional organisation.

Dr Sinclair : But one would expect that.

CHAIR: My understanding is that the New South Wales branch has endorsed the Dutton bill but previously has not supported it and in fact sought to work with the government. Isn't this now a contradiction? Perhaps you can enlighten the committee as to why you appear to have changed your position.

Dr Sinclair : Any direct interface with the sovereign government was done through the federal body. The New South Wales branch, while endorsing the intent of the bill, has not had any direct interface, to the best of my knowledge. I am happy to be corrected, but in my time I cannot remember interfacing directly with a federal minister in respect of this communication.

CHAIR: To ensure that it is correct on the record, when this bill was brought forward by the minister at the time, Tony Abbott, you were not consulted. You obviously have concerns with the implementation of it. Were you involved in any lobbying to stop the passage of the bill that went before the Senate on three occasions to close down the scheme?

Mr Rupasinghe : Would you repeat the question. Were we involved in any lobbying?

CHAIR: Yes. There is now obviously huge concerns across the board from a lot of your profession. When the bill was first introduced by the Howard government under Tony Abbot as the minister, were you involved in seeking to block the changes that were sought and denied on three occasions in the Senate to close down the scheme?

Mr Rupasinghe : No.

CHAIR: The submission that the AMA made to the inquiry states their belief that no profession should be exempt from meeting the legal requirements of Medicare. Would you care to respond?

Dr Sinclair : I think that is an entirely reasonable position for the medical profession to take. Bear in mind that the medical profession have had a direct interface with Medicare for 30 years, and to some degree Medicare maintains an intensive compliance and audit review process specifically directed at medicos, even after 30 years of direct interface. This is our first direct involvement with Medicare except for, as my colleague said, a small cleft palate and lip scheme. This is the first time this profession has had a direct interface with a sovereign Treasury fund. Notwithstanding the rights that any government has to impose compliance schedules and audit processes, given that this is our first taste of involvement with Medicare, the results for us if these compliance schedules are adhered to strictly include some absolutely calamitous repercussions for a group of dentists—so much so that there are several who are considering bankruptcy.

Dr Pinchback : Could I make some comments, please, in relation to the AMA submission. I would just like to read a couple of sentences from it:

… the AMA contends that there are remedies available within Medicare’s existing compliance approaches.

…   …   …

We assume that Medicare has taken the stepped approach described above when assessing the degree of any non-compliance by dentists.

…   …   …

… we are confident that Medicare does have and uses discretion to take recovery action … The "action" taken by Medicare … needs to be fully understood before any assessment can be made that the dentists were subject to a different approach.

CHAIR: In relation to submissions that we receive that highlight that, in the submitters' view, there has been overservicing—in fact, you were in the room when I asked your national body about overservicing and the issue of bridges and such—do you see that there is some justified concern that there has been some overservicing?

Dr Sinclair : I would reiterate what my federal colleague has stipulated, and that is that I think there was a vast need for delivery of service, particularly amongst that group of people who have previously had no access to service. I think that, if you drill down hard enough into these figures with any publicly funded scheme, it would be naive of us to say there has been, without question, no overservicing. I think that is a naive proposition, but what I can say is that on balance I think the treatment needs of this group that previously had not had any access to care have been well met.

CHAIR: My final question is one about education. In light of the fact that there was a change in that this legislation was enacted, when you are dealing with taxpayers' money wouldn't there be an onus upon the associations of the profession and the professionals involved—we have had evidence that there was a 65-page document that was made available which would outline the responsibilities—to ensure that they were compliant?

Dr Sinclair : I think that is an entirely reasonable proposition, but the nature of the compliance and the ramifications of noncompliance were such that I do not think that has been clearly educated at all in the processes that have been delivered. To think that a profession as well regarded and tangibly well educated as the dental profession could then, after a balance of time, realise that most of the profession was largely non-compliant, when we have no history of wilful malfeasance or acting in accordance with anything other than the highest professional standards, raises a simple question: quite patently the education process, despite what has been said, was manifestly poorly delivered and poorly presented.

Mr Rupasinghe : We would say that for at least the first 2½ to three years Medicare Australia, the Department of Human Services and the Department of Health and Ageing basically just turned their backs on this scheme and provided little or no information that was relevant to dental practitioners. We say in our submission that we think it is patently clear that both organisations thought this scheme was going to be closed very, very early on. There are numerous occasions that we point out where we have tried to approach them for information and they have just said no; the scheme is going to be closed, so what is the point?

As to the question about whether the profession bears some responsibility, we would say no. We bear no responsibility for this. This is a situation that has been made by Medicare Australia and the Department of Health and Ageing.

CHAIR: In response to that, I am not sure that ignorance has been accepted as an excuse for not meeting legislative requirements in a whole range of areas. But, unfortunately, we have run out of time.

Senator BUSHBY: It is relevant to penalty, though.

CHAIR: Sorry?

Senator BUSHBY: Ignorance may not be relevant to guilt but it is relevant to penalty.

CHAIR: We are talking about the bill that is before us.

Senator FIERRAVANTI-WELLS: Chair, can I ask one very short question?

CHAIR: One very short question, Senator.

Senator FIERRAVANTI-WELLS: In relation to the number of audits, do you have a breakdown of where they are across Australia and how many of those are in New South Wales? This refers to your table on page 3 of your submission. Could you provide a breakdown to me, if you can; otherwise, take it on notice.

Dr Pinchback : We have about 250.

Senator FIERRAVANTI-WELLS: In New South Wales?

Dr Pinchback : Yes, we do.

Mr Rupasinghe : Those are our members. There may be other dentists in New South Wales who are either not members—

Senator FIERRAVANTI-WELLS: So the whole of New South Wales?

Dr Pinchback : About 50 per cent in total.

CHAIR: Can I thank you for your submission and particularly for taking the time to come and give your evidence here this morning.

Proceedings suspended from 10:46 to 11:03