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Thursday, 24 March 1994
Page: 2196


Senator HERRON (1.21 p.m.) —I rise to support my colleague Senator Newman. I wish to speak on three matters: privacy, sledgehammers and fraud. The privacy aspects have been of considerable concern, and evidence on privacy has been given to the Senate Standing Committee on Legal and Constitutional Affairs—in particular by Mr Terry O'Gorman, the Vice-President of the Queensland Council for Civil Liberties. The point was made there should be no circumstances where an individual patient should be denied the knowledge that access has been provided to clinical details relating to that person. It would be absolutely monstrous if that were to occur. I am sure the minister would not like details of any blood tests done on him in relation to HIV or a sexually transmitted disease to become the concern of public servants poring over the details. Members of the public would not want public servants going through details of their medical histories. Do not tell me that this information can be kept private once it gets into the department; it is not possible for that to occur. It would appear that under the provisions, not only would the patient not be aware that this was occurring, but those details would also be available to the bureaucracy.

  On the matter of sledgehammers: this bill is using sledgehammers to crack walnuts. The department is being given unprecedented police powers to go in and search documents that will be available to it under this legislation. The department itself has indicated that the overwhelming bulk of investigations are in relation to very small amounts. The figures that were plucked out of the air last year were in relation to an extrapolation of what occurs in the United States, where 10 per cent of a person's bill may go in fraud or over-servicing—or eight per cent, or seven per cent and various billions of dollars.

  I do not think the public is aware that every individual medical practitioner in Australia has a file on him or her over in Medicare headquarters which details the number of patients that he or she sees, the number of pathology tests that are ordered, the number of X-rays that are ordered and the name of the radiologist who provides those X-rays and the pathologists who do those blood tests. That information is available in detail. The computerisation of records and the pay-out under Medicare is extraordinarily well documented. It is the right of any doctor to request a print-out every six months of his or her pattern of practice.

  A couple of times I have been over at Medicare headquarters and looked at the details provided. It is Big Brother of the future that is here in the present. The department is well aware of the networking that is available, and it is possible for it to survey from time to time and see who should be investigated.

  The extent of fraud, as Senator Lees said, is entirely hypothetical. If we look at the medical practice as a whole, there are only two avenues where there are vast sums involved: radiology and pathology. Individual medical practitioners work on a fee-for-service basis—they see a patient, get paid a fee, and the patient gets a refund from Medicare, so that is fairly easy to control. If the department is really serious, it should be looking at the two major avenues of fraud, and in particular pathology, because it is the only one in which vast sums are going back and forth. There has been an increase in pathology services of about 30 per cent over the last five years. The department has the cooperation of the Australian Society of Pathologists in that regard.

  The third point that I want to raise is fraud itself and the powers given to the department in relation to the investigation. In his letter in the report, Mr O'Gorman said:

Therefore, I repeat my observation that the increased lease powers, the subject of the bill, will be used widely and frequently across the range of general practitioner surgeries, specialist rooms, pathology providers and even pharmacists.

So we have this spectre of Big Brother across the whole procedure. I will look with interest over the next year or two, and hopefully beyond that, to see just how much money is involved in the extraordinary powers that we are now giving to the bureaucracy in terms of investigation, because I believe it will be peanuts. Given the already large facilities that are available to the department in the investigation of fraud at present, I completely support my colleague in the introduction of a sunset clause. Otherwise, we will have yet another bureaucracy set up to look at the provision of medical services. It will get lost in the bureaucracy, there will be more bureaucrats and more control when, ultimately—and I am quite confident of this—it will be found that what we are erecting here is a giant machine to crack a few nuts.