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Monday, 19 March 2012
Page: 3207


Mr DUTTON (Dickson) (10:38): I introduce this bill, the Health Insurance (Dental Services) Bill 2012, today to redress an injustice that the government appears determined to inflict upon the nation's dental health professionals. My intention is that, once enacted, this bill will require the government to redress past and future inequities that have arisen from the operation of subsection 10(2) of the Health Insurance (Dental Services) Determination 2007. The bill describes the inequities imposed on dental practitioners by the operation of the subsection of the determination and specifies five courses of action which the minister can take to redress these inequities. It establishes a time frame in which action is to be taken and requires a report to be tabled in both houses of parliament, detailing the actions taken.

It is unfortunate that it has come to this, and it would not have done so if the ministers of this government had an ounce of common sense and a skerrick of decency and compassion. Members of this government, both in government and previously when in opposition, have stubbornly opposed Tony Abbott's chronic disease dental scheme, a billion dollar investment into dental services introduced by the former health minister, Tony Abbott. It provides for general practitioners to refer patients with a chronic disease or complex health problems to dental professionals for treatment up to the value of $4,250 over any two years.

The Rudd and Gillard governments have tried twice to close Tony Abbott's chronic disease dental scheme, but these attempts have been rejected by this parliament. They seek to discredit the scheme simply because Tony Abbott was its architect. Unable to close the scheme, the government changed tack, deciding to denigrate it, perhaps in the hope that this would garner enough public support to force closure. And so we have ministers describing the scheme as full of rorts and being constantly rorted. To date they have produced not one iota of proof to back these claims, yet they continue to make these false allegations. In making the allegations they are slandering the entire dental profession.

Let me make it clear: the coalition does not defend anyone who has done the wrong thing. If there are dentists who have indeed rorted this Commonwealth health program then they should be held accountable, weeded out and punished to the full extent of the law. But that is not what we are talking about here. We are talking about the good, honest, community-minded dental health practitioners who have provided dental services under the chronic disease dental scheme. They have done the right thing by their patients; patients are satisfied with the treatment they have received. These dentists have expended money to provide these treatments; they have bulk-billed, ensuring there were no out-of-pocket costs for the patient in many cases. They have claimed the appropriate Medicare benefits to which they are entitled, benefits that do not always cover the cost of the treatment, only to now find themselves being pursued with demands for repayment from Medicare. Their sin was either a technical failure to provide their patients with written treatment plans and quotations for the services to be provided or failing to forward details of the treatment plan to the general practitioner who had referred the patient for dental treatment. Essentially, they have provided treatments but failed to provide the paperwork as required by subsection 10(2) of the Health Insurance (Dental Services) Determination 2007.

Yes, they have technically breached the law. That is true. But in the eyes of any sensible person clearly they are guilty of a technical breach of the law only. Any sensible or fair-minded person would exercise discretion in their dealings in such circumstances, but that is not what this government or Medicare, under the government's direction, are doing with members of the dental profession. They say they are, but the facts prove otherwise.

In mid-2010 the then Minister for Human Services, Mr Bowen, established an audit task force to investigate the compliance of dentists with the scheme. In a media release at the time he stated:

Medicare Australia has had ongoing concerns about compliance with the scheme, as it has identified dentists claiming for work they have not provided and claiming when they did not meet the legal requirements of the scheme.

He went on to say:

I understand that most dentists try to do the right thing and that the majority of incorrect claiming is accidental.

That is what this government says, but what it does is very different.

11,713 dentists have provided treatment under the chronic disease scheme. They have provided more than 11 million treatments to around one million Australians, the vast majority of whom are the most needy and who have not had access to dental services for years. That is the scheme that Tony Abbott set up, investing $1 billion into helping those people most in need of dental care. On the latest figures available, Medicare has 933 audits of those dentists either active or under consideration—629 are underway or completed and 89 cases have been closed. Here is the important statistic. Of those 89 dentists, 26 were found to be compliant with the scheme, while 63—basically two-thirds of the dentists—were noncompliant. Ask yourself: in a scheme where two-thirds are noncompliant, is the problem with the dentists or with the government's failure to explain the requirements of those dentists under that scheme? Only 12 of those 63 were found to have not provided the services for which they had claimed benefits and, in some of those cases, it may be that the services were to be provided in the future. So there are some question marks over those 12. It may not be the case that all of them were acting wrongly.

But the important point here is this: the bulk of dental professionals falling foul of the requirements of the chronic disease dental scheme were actually doing so because they were failing to fill in required paperwork. They were not rorting anything. I would have thought that common sense would tell any person or organisation that, when it is finding that two-thirds of a particular group of people are noncompliant with the requirements imposed upon them, something must be wrong in the totality of the situation. There is, and I will come to that later. I do not think anyone would argue that two-thirds of one group of people, in this case dental professionals, are out there deliberately doing the wrong thing or, as the government would have it, rorting this scheme, but dental professionals are being pursued as if that is exactly what is happening and as if they are rorters.

Medicare knows that they are not. Appearing before a Senate estimates hearing in October last year Medicare officials said:

In terms of the claiming behaviour, it is essentially around not providing the treatment plan to the patient, not providing an itemised quote to the patient and not providing a summary or copy of the treatment plan back to the GP. They are essentially the non-compliant activities that have been occurring.

At this point there are hundreds of dentists, dental specialists and dental prosthetists who have been audited and are awaiting a demand from Medicare for repayment of all the benefits they have claimed and been paid. Scores are already dealing with this reality. These actions are having financial, emotional and psychological impacts on people who are respected professionals and community members who saw treating people under the chronic disease scheme as a civic duty. There have been many letters and emails sent to my office. Let me quote from just a few. The first one says:

I and the bulk of my colleagues have helped a large number of sick and disadvantaged people improve their oral health and then (we) are going to be seriously punished for not complying with certain paperwork requirements which were not properly explained to us. Since I have treated a large number of these people this could send me into bankruptcy.

Another said:

I feel very helpless as the way I see it, my and my wife's and kids' future lies in the hands of a questionnaire that has been sent to patients some three years after the completion of their treatment. How are they meant to remember which date they received a treatment plan from my office. If they get it wrong I would be up for a full refund. I have 11 staff and 4 dentists working in my practices. If I am asked for a hefty refund, I will have no choice but to go bankrupt and let all these employees go.

Another said:

I looked upon it—

the scheme, that is—

as an opportunity to help the underprivileged and ill people in my suburb … often there were not enough funds available from Medicare yet these patients were treated at no extra expense to themselves …

… the extent of the witch-hunt over alleged rorting … has become unreasonable …

I have become anxious, do not sleep at night and have become extremely stressed since this audit has started.

For most in the dental fraternity, the Chronic Disease Dental Scheme was the first time they had interacted with Medicare. They were not familiar with the paperwork requirements that go with obtaining benefits from Medicare for the provision of health services. In fact, the common practice in dental practice is to deal with matters verbally—to discuss problems and possible courses of treatment with patients. The profession as a whole argues that since the scheme was established in 2007 up until at least mid-2010 most dentists were not properly informed of the requirements placed upon them under the chronic disease scheme. Indeed, some dentists argue that they were still receiving conflicting information from Medicare as late as late last year.

If there is wrong here it is on both sides. Medicare should not be demanding repayment from dentists who have acted in good faith and provided treatment but failed to comply with the paperwork they were expected to file—paperwork requirements they say they were not informed about. The work has been carried out. I commend this bill to the House because it is incumbent upon the government to get this problem right. It is a problem of their own making and they should sort it out. This bill enables the government to do just that.

Bill read a first time.

The DEPUTY SPEAKER ( Mr S Georganas ): In accordance with standing order 41(c), the second reading will be made an order of the day for the next sitting.