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Monday, 26 October 2009
Page: 10990


Mr ABBOTT (4:48 PM) —I do not propose to detain the Committee long on the Health Insurance Amendment (Compliance) Bill 2009, but I do wish to make a few observations about the approach that the opposition intends to take to it. I begin by reaffirming that the opposition strongly supports Medicare. Indeed, it used to be said under the former government that it was the best friend that Medicare had ever had. Many members of the current government were probably sick of hearing that statement, but I think that the former government did by its actions abundantly justify that statement. Obviously, if Medicare is to work—if it is to function effectively—there have to be meaningful mechanisms to tackle fraud and overservicing.

At the moment, the Chief Executive Officer of Medicare can request information from doctors who are reasonably suspected of engaging in inappropriate or improper practices. The CEO of Medicare reports that some 20 per cent of doctors who are asked to provide access to patients’ medical records refuse to do so. The government believes that of that 20 per cent many are quite possibly engaged in improper or inappropriate practices. I would suggest to the Main Committee that it could equally be that they simply do not believe that it is ethically proper of them to provide their patients’ medical records to a third party, even a third party as eminent as the CEO of Medicare.

This legislation seeks to give the CEO of Medicare the power to require the production of patients’ medical records rather than just request them. I should point out that this strikes me and the opposition as a rather heavy-handed solution to a problem that may be more apparent than real. For instance, every year some $4.5 million is recovered from doctors in Medicare payments which turn out to have been inappropriately claimed. That suggests, firstly, that there are mechanisms in place to recover moneys from doctors who have inappropriately claimed and, secondly, that it is not such a shocking problem given that $4.5 million, while a lot of money in itself, is a minuscule percentage of the $14 billion or thereabouts that Medicare disburses every year.

Five convictions on average are secured every year against doctors for improperly claiming Medicare benefits. Obviously, five is five too many but when we remember that there are some 55,000 doctors registered to claim Medicare benefits, the fact that in any one year five do so improperly suggests that the vast majority of doctors are working entirely appropriately under the system. I would be very disappointed to think that this government was engaging in doctor bashing. The last thing that we should do if we want our health care system, and in particular Medicare, to function well is to assume that all doctors are cheats. Medicare only works because of the goodwill and integrity of the medical profession. I believe it is important for the government and the parliament to work with the profession rather than against it in matters such as this.

I wonder whether it would not be more appropriate and ultimately more productive, when the CEO of Medicare believes that there may be some grounds for suspecting that benefits have been claimed improperly or inappropriately, if rather than issuing a notice requiring a doctor to produce medical records the CEO instead sent a Medicare official to the doctor’s practice to be there with the doctor on site to inspect the relevant records. This, I think, would be a simpler and more collegial way of ascertaining the true facts of the situation and in the long run more likely to get to the truth of the matter than the issuing of notices to produce records.

If it really does seem to the CEO of Medicare that something improper has taken place, there are already mechanisms for securing access to patients’ records, mechanisms which have been in place for many years and which are well regarded in terms of the privacy provisions surrounding them. There is the possibility of a professional services review or, if that is regarded as insufficient, the possibility of bringing action in court against the doctor concerned. At least on the face of it, this legislation strikes me as going too far and as giving a power to the CEO of Medicare the necessity for which is far from clear. Without wishing further to detain the Main Committee and without wishing to move amendments at this stage of the bill, I foreshadow that the opposition is looking at some amendments which we will consider in another place.