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Tuesday, 15 November 1983
Page: 2689


Dr BLEWETT (Minister for Health) —by leave-I wish to inform the House of action already taken or being taken by the Government to deal with the serious problems of medical benefits fraud and overservicing. The Government has already made it clear that it will not tolerate these abuses and that it is very serious about its intentions significantly to reduce the magnitude of the problems. Medicare will be a major social reform designed to provide all Australians with security against the costs of basic health care services in a more equitable, logical and administratively efficient manner. However, it is necessary that strong measures to combat abuses of these arrangements should also be an integral part of Medicare.

I should emphasise that measures to combat fraud and overservicing are necessary whether health insurance arrangements are based on a single public fund, as will be the case with Medicare, or on private health insurance funds as is currently the case. Indeed, I must point out that the measures proposed by the Joint Committee of Public Accounts for dealing with the major problems of medical fraud and overservicing were put forward during the former Government's term of office and in the context of the current health insurance arrangements.

In announcing details of the Government's plans for curbing medical benefits fraud and overservicing, I wish to make it quite clear to the House that those plans do not in any way constitute an attack on the medical profession as such. The Government is keenly aware that the great majority of members of that profession are people of integrity and are highly dedicated to the care of their patients. The place of those doctors in our community will continue to be respected and they have nothing to fear from the measures which I will outline to the House. However, it is also a most regrettable fact that some members of the medical profession are abusing their position of trust in the community and the high standards of their profession. It is these persons against whom the Government's actions are directed.

In approaching the task of combating medical fraud and overservicing, the Government has been greatly assisted by reference to progress report No. 203-' Medical Fraud and Overservicing'-by the Public Accounts Committee as previously constituted. This report has been of great value in the planning of measures to overcome these problems, and on behalf of the Government I wish to express appreciation of the work of that Committee. In accordance with established procedures, the Minister for Finance (Mr Dawkins) has forwarded to the Chairman of the current Committee a Finance minute containing responses to the recommendations contained in the report. This Finance minute was tabled in the Parliament today.

Concerning the magnitude of these problems, the Public Accounts Committee's report noted an estimate by the Department of Health that fraud and overservicing account for 'at least $100m per annum', based on data derived from medical benefits claims paid during 1980-81. Although the Committee described that estimate as 'far from precise', it expressed a belief that the estimate was 'conservative'. I now wish to inform the House that the estimate has since been calculated again using data from the 1981-82 financial year. The method of calculation was the same as that used to deduce the original estimate of $100m for 1980-81. Details of the methodology were set out in my Department's submission to the Public Accounts Committee.

In brief, the methodology was as follows: My Department calculated for each doctor in the country the average schedule fee cost per quarter per patient. This was then compared with the average cost calculated for other doctors in the same branch of medicine and in the same State, whose schedule fee cost was more than $4,000 in the same quarter. In those cases where an individual doctor's average cost per patient exceeded that of his peers, the difference was multiplied by the number of patients he saw in the quarter and then summed for all such individual doctors.

This gives a total deviation figure which is comprised of legitimate deviation, resultant from the unique practice circumstances of individual doctors, and a large proportion of the total fraud and overservicing. The difficult part of the exercise then is to determine how much of the total deviation figure is fraud and overservicing and how much is legitimate. Based on observation of the distribution of cost per patient across doctors, which indicates that the majority of the deviation is contributed by a relatively small number of doctors with very high individual deviation figures or substantially higher average cost per patient, and on the experience of departmental officers who examine doctors' profiles, it is estimated that the legitimate causes of deviation could account for up to one-third of the total deviation. After allowing for legitimate deviation, a conservative estimate of the cost of fraud and overservicing to the Australian community in respect of 1981-82 was $120m, an increase of $20m over the previous year.

The original method has now been refined, for general practitioners only, to incorporate more rigorous statistical techniques thus eliminating two sources of conjecture, namely, the selection of an acceptable base point from which to measure deviation and the extent of acceptable deviation around that base point. To achieve a true or typical base point, the average cost per patient of general practitioners in each State was calculated from that subset of doctors left after excluding those whose practice patterns exhibit unusual features. The acceptable range was then determined as being the average plus or minus 1.6 or 2 .0 standard deviations. It should be noted that in New South Wales, for example, the average cost per patient and the standard deviation of average cost per patient for all full time general practitioners is $31 and $28 respectively, whereas the same figures for the normal subset are $26 and $5 respectively. Using 1.6 and 2.0 standard deviations as the acceptable spread around the average and extrapolating to include all specialities, the deviations obtained are $150m and $130m respectively. As the method is designed to eliminate, on a statistical basis, legitimate deviation as a component of total deviation, the result fully supports the estimate of $120m as a conservative estimate of fraud and overservicing.

However, this does not imply an increase in the overall scale of fraud and overservicing, but reflects an increase in the schedule fee cost between 1980-81 and 1981-82. In proportionate terms, the estimate for 1981-82 is at about the same level as that for 1980-81.

As announced by the Treasurer (Mr Keating) in the 1983-84 Budget Speech, expenditure on measures to counter fraud and overservicing in relation to medical insurance will be increased from about $4m to about $8m per annum. The Government is very conscious that this is a high level of expenditure which should be unnecessary in an ideal world. However, the realities of the present situation are that relatively heavy expenditures are necessary if we are to mount a concerted attack on these complex problems, and those expenditures must be measured against our current losses of around $120m a year. I should also point out that some action towards the allocation of increased resources to combat medical fraud and overservicing was initiated by the former Government, even before the tabling of the progress report of the Public Accounts Committee.

To illustrate the magnitude of the particular problem of medical benefits fraud and overservicing and to indicate the difficulty of overcoming that problem, I draw to the attention of honourable members the statistics appended in tables 1 to 4. I seek leave to have these tables incorported in Hansard.

Leave granted.

The tables read as follows-

Table 1

MEDIFRAUD CASELOAD AT 1 OCTOBER 1983

Suspected provider fraud matters listed for, or under active investigation with Department of Health 382 Provider fraud matters referred by Department of Health to Australian Federal Police for further investigation/prosecution 53 Provider fraud matters referred by the Australian Federal Police to the Deputy Crown Solicitors for institution of proceedings 31 Provider fraud matters before the courts, awaiting hearing or appeal 30

Table 2

REFERRALS OF PROVIDER FRAUD TO THE POLICE BY DEPARTMENT OF HEALTH FOR LAST THREE YEARS

1 July 1980-30 June 1981 47 1 July 1981-30 June 1982 47 1 July 1982-30 June 1983 55 1 July 1983-30 September 1983 (Quarter year only) 32

Table 3

PROSECUTIONS OF PROVIDERS FOR MEDICAL FRAUD OFFENCES FOR LAST THREE YEARS

Charges proven

but no Unsuccess-

Convictions conviction ful Total

1 July 1980-30 June 1981 12 3 1 16 1 July 1981-30 June 1982 10 9 1 20 1 July 1982-30 June 1983 5 8 8 21 1 July 1983-30 September 1983 1 4 0 5

62

Table 4

NUMBER OF DOCTORS COUNSELLED AND EXAMINED FOR OVERSERVICING-1 JULY 1975 TO 30 SEPTEMBER 1983

No. of

Cases

Doctors counselled with respect to possible overservicing (since April 1977) 3774 Cases currently before Committees of Inquiry 38 Committee of Inquiry cases completed 60 Ministerial determination* 31 Awaiting Referral to Committees of Inquiry 61

* In response to recommendations of a Committee of Inquiry the Minister is able to determine that the doctor be reprimanded, further counselling take place, benefits be repaid or benefits be withheld.


Dr BLEWETT —In particular, honourable members may note that at the end of September this year 382 persons, mainly medical practitioners, were listed for preliminary investigation by my Department. At the same date 53 other cases were with the Australian Federal Police for formal investigation and a further 61 persons were before the courts or receiving attention by Deputy Crown Solicitors . On the overservicing side of the problem, 61 doctors are awaiting referral to medical services committees of inquiry, and 38 cases are currently before the committees. During recent months, considerable progress has been made in planning and undertaking action to deal with medical fraud and overservicing, with first priority being given to medical fraud. This has included the allocation of substantially increased personnel and other resources, improved direction and co-ordination of action, and the upgrading of training programs.

One of the more general matters addressed in the report of the Public Accounts Committee was the management system of the Department of Health. I am pleased to inform honourable members that the overall administrative efficiency of the Department has been reviewed and a number of initiatives have been taken to give new direction and thrust to the Department. These include the following measures : A review of the top structure in Central Office and Regional Offices to strengthen performance of the Department's administrative functions; the development of specified goals and objectives for the Department and for its constituent divisions, branches and regional offices; the appointment of management consultants to review goals and objectives, to develop management-by- objectives protocols and to recommend management information systems for development within the Department; the appointment of consultants to review the Department's total training and staff development programs and to develop a long -term staff development plan; the institution of a program for the review of departmental program guidelines; the appointment of a management committee, chaired by the Director-General of Health, to overview the management and operations of the Department; and greater co-ordination between central office and regional offices in relation to uniformity of decisions and procedures for the administration of programs.

In relation to personnel, my Department's central investigation teams, consisting of six experienced investigators, was formed early this year to make rapid inroads on the considerable backlog of matters needing investigation to determine whether medifraud was involved. The team operates nationally as an adjunct to the Department's regional investigation teams: It commenced operations in April this year and had already completed investigations of over 94 suspected fraud cases, leading to 28 briefs of evidence being referred to the Australian Federal Police.

In my Department's regional offices the total number of positions allocated to activities related to medical fraud and overservicing has been increased this year from 76 to 146. The development of these positions in each State is set out in table 5. I seek leave to have table 5 incorporated in Hansard.

Leave granted.

The table read as follows-

Table 5

SURVEILLANCE AND INVESTIGATION POSITIONS-STATES

Medical Investigation Monitoring Committee

Counsellors OIC Support Group Group Support Total

New South Wales 5 1 1 16 16 6 45 Victoria 3 1 1 11 11 5 32 Queensland 1.5 1 1 7 7 4 21.5 South Australia 1 1 1 7 5 4 19 Western Australia 1 1 2 7 5 4 20 Tasmania 0.5 1 1 2 2 2 8.5

12 6 7 50 46 25 146

Note: 1. Investigation Group comprises 42 Investigation Officers and 8 Support Staff.

2. Further Investigation Officers (2 in Sydney and 2 in Melbourne) are outposted from the Central Task Force and will, when not engaged on Task Force duties, supplement State Investigation Groups.

3. Committee Support consists of 25 positions involved in fraud and overservicing activities. A further 9 positions are included in the States organisation to provide support to unrelated statutory committees such as Specialist Recognition Advisory Committees and Nursing Homes Fees Review Committees: these positions are not shown above.


Dr BLEWETT —These staff fall into five main categories with the following broad functions:

Medical counsellors who provide advice and guidance to doctors on the requirements of the medical benefits system.

Monitoring staff who analyse computer-generated reports on the practice patterns of doctors, and who refer suspected fraud cases to investigators or suspected overservicing cases to medical counsellors.

Investigators who follow up allegations by the public and information received from the monitoring staff by interviewing patients to establish whether offences have occurred, who refer evidence to the police, and who assist in the execution of warrants and in court prosecutions.

Committee secretariat staff who support the meetings of the existing eight medical services committees of inquiry around Australia which provide peer assessment of suspected overservicing by doctors; and

State officers-in-charge and their administrative support staff, who manage operations in their respective regions, under guidelines from the Department's Central Office.

Of these 146 regional positions, placements in 99 are finalised; a further 16 are at the point of promotion or appointment; 18 are awaiting Public Service promotion appeal hearings; and 13 are subject to selection decisions or readvertisement. The Department expects to have these regional sections up to full complement by about the end of March 1984. The Department's Central Office fraud and overservicing area has been reorganised into a new Surveillance and Investigation Division, increasing from 24 to 59 positions. Table 6 shows their deployment. I seek leave to have table 6 incorporated in Hansard.

Leave granted.

The table read as follows-

Table 6: Surveillance and Investigation Positions-Central Office

Fraud and Overservicing Detection System Design and Developoment 16 Overservicing Committees and Review Tribunals Administration 7 Overservicing Project Development 7 Fraud Investigation and Training 9 Fraud Prosecution Project Development 4 Fraud Disqualification and Administration 9 Divisional Management and Principal Medical Officer 7

59


Dr BLEWETT —The positions fall into the following seven main categories:

Fraud and overservicing detection system design and development staff who are to refine the current computer-based monitoring system, as well as training regional officers in its use.

Overservicing committees and review tribunals staff who deal with formal submissions on findings of committees of inquiry, committee and tribunal appointments, and other administration related to the current overservicing control system.

Overservicing project development staff who will design and specify the details of the new overservicing control system, to which I will refer later in this statement.

Fraud investigation and training staff, who include the investigators in the central investigation team, with a small group to run the investigation evaluation and training program for the Department.

Fraud prosecution project staff who will examine every aspect of the existing legislation to insure that prosecutions do not fail through ambiguities or technical loopholes in the law.

Fraud disqualification and administration staff who prepare the procedures and guidelines for regional offices and who will administer disqualification cases as they begin to come through courts early in 1984, as well as handling day to day administration in relation to representations, allegations and similar matters.

Divisional management staff including the divisional and branch heads and a principal medical officer.

The Central Office positions were advertised in September and are currently being filled. The net effect of this reorganisation in both regional and central offices is that surveillance and investigation positions in the Department have increased to 205 from 100 this year, and will be fully operational by about May 1984.

Honourable members will realise that, in dealing with medical fraud, two other agencies are directly involved, namely, the Australian Federal Police and the Crown Solicitor's Office. An extra $4m was allocated in the Budget this financial year to enable the Australian Federal Police to recruit extra staff. The Special Minister of State has authorised me to say that, in deploying the increased personnel that will become available following training, the Commissioner will take account of the priority to be accorded to the investigation of medical fraud. An external review is also getting under way to look at the AFP's deployment of present staff and future requirements. It is expected that this will produce long term benefits in major areas of investigation such as medical fraud.

Concerning legal officers to deal with medical fraud cases, the Public Service Board has approved an increase of 12 positions in deputy crown solicitors' offices. These comprise three principal legal officers, seven senior legal officers and two support staff. Eight of the legal officer positions are occupied-some on an acting basis-and it is expected that the remaining positions will be filled in the near future.

Another particular matter which has come to attention through the recent focus on medical fraud is the need for improved co-ordination between the Department of Health, the Australian Federal Police and the Crown Solicitor's Office. Accordingly, those three organisations have established special joint co- ordination bodies-a central co-ordinating committee based in Canberra and a co- ordinating group in each State. These bodies have been operational for some months and it is considered that they are making a significant contribution to the effective operation of measures to combat medical fraud. In particular, these co-ordinating bodies have been able jointly to address some of the operational problems which confronted the three organisations in the past. They have been able to monitor the numbers of investigation and prosecution cases, have achieved a better utilisation of staff resources and have greatly facilitated the exchange of information between the three agencies so as to promote joint effort. The Department's Central Office has issued further guidelines and procedures for regional offices, covering matters such as disqualification procedures, presentation of evidence in fraud cases, monitoring and reporting systems, security and central investigation team operations.

In relation to legislation, regulations are currently being drafted to ensure that a practitioner who claims benefits for a professional service to a patient but does not actually see the patient-for example, where a repeat prescription is provided without any consultation-is more clearly liable to prosecution than at present. It is expected that these regulations will come into operation on 1 December. I should also mention that regulations have been made to provide that benefits are not payable unless certain basic information appears on practitioners' accounts and receipts or, in the case of direct billing, their assignment forms. These regulations were gazetted on 31 October and will operate from 1 February next year. The information required by these regulations will include the provider number allocated by the Department of Health to a particular practitioner. It is expected that this requirement will be opposed by some members of the medical profession. However, I should point out that the use of provider numbers on accounts and receipts is already practised by many doctors, was the subject of a specific recommendation by the Public Accounts Committee, is based on a regulation-making power which was introduced by the former Government, and is an important measure to improve the accuracy of data necessarily collected by my Department for administrative purposes.

Honourable members will also be aware that, by the Health Legislation Amendment Act 1983, which recently received royal assent, a new provision-section 127-is to be introduced in the Health Insurance Act. The effect of this new provision will be that, in relation to direct billing under Medicare, any practitioner who obtains a patient's signature on a blank or incomplete assignment form or who fails to give the patient a copy of the completed assignment form will be liable to prosecution. The penalty prescribed is a fine of up to $1,000 or imprisonment for a period up to three months, or both. It is expected that this will be a strong deterrent against abuses of the direct billing arrangements under Medicare.

Last year, under the former Government, legislation providing for the automatic disqualification from the medical benefits arrangements of doctors found by a court to have committed fraud on two or more occasions came into operation. The prescribed period of disqualification is three years. I wish to inform honourable members that 37 practitioners already face such disqualification if prosecutions currently proposed or pending are successful in the courts.

Another matter which is receiving increasing attention within my Department concerns the further refinement of the computer-based system for detecting possible cases of fraud and overservicing and the organisational system for its effective utilisation. Improvements are currently being incorporated into this fraud and overservicing detection system and planning is under way for upgrading the system to increase its operational efficiency. The increases in personnel which I have already outlined include provision for this activity.

Special training programs have also been introduced for personnel concerned with measures to combat fraud and overservicing, and these will be progressively improved in the light of experience. The Department of Health held a medical benefits fraud investigation training course for 21 officers in September. Earlier this year, the Department combined with the Australian Federal Police on two courses and with the Crown Solicitor's Office on one course, covering the investigation and prosecution of medical benefits fraud. Induction courses and basic training on the computer-based fraud and overservicing detection system are also currently in progress for new staff in all regions of the Department of Health. This initial program will be largely completed by mid-December, but further training in the more complex aspects of the fraud and overservicing detection system will continue throughout the remainder of this financial year.

In relation to overservicing-more correctly referred to as 'excessive servicing '-my Department is currently working on the development of a new system for dealing with this very complex problem. Last year a special working party was set up to explore suggestions for improvements in the arrangements for dealing with overservicing. The working party comprises officers of the Attorney-General 's Department and the Department of Health and representatives of the Australian Medical Association. The deliberations of the working party have now reached the point where preparation of its report, for consideration by the Government and by professional organisations, is currently under way. I understand that the report will give particular attention to the following matters:

Extensions of measures for educating medical practitioners-especially newly graduated practitioners-in the operation of the Medicare arrangements, with particular reference to the question of overservicing;

the systematic provision of information to professional organisations regarding apparent overservicing trends and practices which give rise to concern by the Department of Health, so that those organisations may seek to exert peer pressures where they consider it appropriate to do so;

the establishment of a new system of tribunals which would replace the current system of medical services committees of inquiry; and

appeals from decision of those tribunals would be to the Administrative Appeals Tribunal rather than to the existing medical services review tribunals.

With regard to the possibility of a new system of tribunals, it is likely that the following matters will receive consideration: the tribunals-at least one in each State-might operate on a full-time basis, that is, during normal working hours and as required to meet demand for consideration of cases referred to them ; the tribunals might comprise three members-a legally qualified chairperson plus two medically qualified members, the latter selected from a panel of practitioners in the same branch of medicine as the practitioner whose practice is under consideration; the tribunals could be decision-making bodies with power to order repayment of benefits by practitioners found to have overserviced. There could be a right of appeal against a tribunal's decision to the Administrative Appeals Tribunal; the tribunals could be authorised to conduct their proceedings in a relatively informal and flexible manner, not bound by rules of evidence; provision could be made for the tribunals to order the Department of Health and the practitioner under referral to participate in a closed preliminary conference before any formal hearing, in order to identify matters in dispute and to explore whether there are any prospects for settlement without a formal hearing. Of course, it will be necessary for details of any proposed new system to receive consideration by Cabinet before implementation.

I should also mention that, in its examination of suggestions for a new system for dealing with overservicing, my Department has been paying close attention to the relevant recommendations contained in the Public Accounts Committee progress report No. 203. All the elements which I have mentioned-the allocation of increased resources, improved co-ordination, improved detection and training programs, and so on-are being drawn together to constitute a special new surveillance and investigation program. This program will have a basic objective of substantially reducing the problems of fraud and overservicing within a period of approximately five years, and with provision for a progress report to the Government by the end of 1985. It may seem that the five-year period set for this program is unduly lengthy. However, the problems of medical fraud and overservicing are of considerable magnitude and complexity. A realistic assessment clearly indicates that quick remedies cannot be expected.

As I have already mentioned, there are particular difficulties involved in developing a new system for dealing with overservicing. This is partly due to the fact that subjective judgments are required to decide whether or not services provided were reasonably necessary for the adequate medical care of the patient. The Government is also very conscious of the need to ensure that the operation of any new system does not create situations where doctors are deterred from providing their patients with an adequate level of care and attention. Furthermore, it is necessary to recognise that sometimes practitioners may be placed in a position where a patient directly or indirectly seeks services which could reasonably be regarded as unnecessary. Another important elementary point is that, although intentional overservicing by a doctor clearly constitutes serious abuse, no criminal offence is involved because the services have been given. These types of issues present substantial problems in the development of a new system for tackling the difficult and sensitive topic of overservicing.

In relation to cases of fraud, one area of concern is that of delays in having these cases dealt with by the courts. With the significantly increased activity to be undertaken in this area, the number of prosecutions for medical fraud can be expected to rise considerably. It remains to be seen whether our legal system is able to deal with the increased number of cases without unacceptable delays. Notwithstanding obstacles such as these, the Government is firmly resolved to break the back of the problems of medical fraud and overservicing, which are so costly to the Australian community and which are entirely contrary to the principles on which the practice of medicine is founded. The Government welcomes the resumption of the Public Accounts Committee inquiry into these and related matters. The Committee may be assured that its proceedings will receive the Government's close and continuing attention.

It may also be of interest to honourable members that the Government has taken and is taking certain measures to deal with abuses related to payments in respect of private hospitals, nursing homes and pharmaceuticals. During the current sitting, amendments were made to the Health Insurance Act to provide substantial penalties in a situation where the proprietor of a private hospital and a doctor conspire to benefit financially from the admission of a patient to a private hospital. In addition, there are new legislative provisions that tighten up the control of the Commonwealth bed-day subsidy payments. For example , the subsidy will not be paid for a length of stay of less than eight hours, and there are strengthened powers for the inspection of records of private hospitals and to obtain information relevant to the private hospital or the payment of the daily bed subsidy. Apart from these legislative changes, steps have been taken by my Department to provide a more secure computer claims processing system for private hospital subsidies from 1 February 1984. A greater range of pre-payment checks will be made on the validity of claims, and a broader range of computer-generated statistical reports for use as guides to unusual or fraudulent claiming patterns will be produced.

Concerning nursing homes, the present system of funding provides little incentive to proprietors to contain costs. Indeed, there is evidence that some proprietors inflate their costs or underincur approved expenditure such as wages , as a means of increasing their profits. A consultancy conducted for my Department in 1982 as a first stage of identifying the actual costs of providing nursing home care found wide variations in costs between similar nursing homes both within States and between States. The consultants concluded that some of these variations could no doubt be explained by fraudulent practices. Further, there have been a number of allegations against nursing home proprietors for having 'ghost' staff on their payrolls. Of course, this practice means not only that fees are higher than justified but also that patient care suffers.

A wages reconciliation program conducted by a regional office of my Department over the past year has led to significant fee reductions since many nursing homes were being overcompensated in their approved fees for the wage and salary costs they were actually incurring. Savings of the order of $2.5m are expected in a full year in that State. This reconciliation program is now being introduced in all States. My Department has conducted validations of the costs of selected nursing homes to ensure that the costs allowed for in the fees are actually being incurred and are related to the provision of nursing home care. These validations take considerable manpower and time and so, to date, they have been conducted largely on an ad hoc basis.

Provision was made in the 1983-84 Budget for my Department to engage a consultant to undertake a detailed examination of the actual costs of a sample of nursing homes. This will include identification of any fraudulent practices or overcompensation in fees for actual costs incurred, and will provide proposals for improved methods to detect and investigate nursing home fraud in a systematic manner. The final results of this consultancy are not likely to be available for about 12 months. The present administration of the nursing home funding arrangements is consuming increasing staffing resources as it necessitates officers of my Department investigating many detailed aspects of the cost structures of nursing homes. This situation is exacerbated by the lack of incentive or reward for proprietors to seek to provide cost-effective quality care. However, it is the policy of the Government to replace these cumbersome arrangements with a system of residential care program grants.

I turn now to the pharmaceutical benefits area. My Department for some years has employed a number of pharmacists in its regional offices whose primary role is regularly to visit doctors and pharmacists in relation to the prescribing and supply of pharmaceutical benefits. These visits to doctors are aimed at ensuring compliance with restrictions applicable to the prescribing of pharmaceutical benefit items, to counsel doctors with a view to answering their queries about the scheme, and to curb excessive prescribing or prescribing other than in accordance with any restrictions applying at the time. These departmental pharmacists are aided in their work by computer reports on prescribing patterns. The more serious breaches of the pharmaceutical benefits scheme, including fraud , are made the subject of court action, while less serious breaches and cases where prescribers continue to disregard prescribing restrictions even after counselling, may be referred to a medical services committee of inquiry.

In addition to the 'doctor visitation' program, departmental pharmacists also carry out routine calls on pharmacies to counsel pharmacists about the operation of the scheme and to ensure observance of the relevant requirements. As in the case of doctors, breaches under the pharmaceutical benefits scheme by pharmacists may be made the subject of court action or be referred to a pharmaceutical services committee of inquiry. In view of the ever-increasing Government expenditure on the payment of various benefits, the Department is currently reviewing staffing structures with a view to improving inspection and associated activities for private hospitals, nursing homes and pharmaceutical benefit payments. Resources are needed in both the central and regional offices to evaluate, identify and counter areas of possible fraud relating to private hospitals, nursing homes and pharmaceutical benefits. In addition, there is the need to design, implement and maintain national training programs for departmental inspection and investigation staff to complement the program already being put in place with regard to medical benefits fraud.

In concluding on the subject of medical benefits fraud, I wish to reiterate that the special surveillance and investigation program which I have outlined is not intended to be an attack on the majority of medical practitioners, who are honest and caring professionals. Rather, it constitutes a program to combat practices which are totally contrary to the medical profession's own high standards. It deserves the support of responsible members of the profession and of the community generally.