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Thursday, 21 June 2012
Page: 4019


Senator BUSHBY (TasmaniaDeputy Opposition Whip in the Senate) (09:37): I rise today to speak on the Health Insurance (Dental Services) Bill 2012. This is a bill that I have introduced into the Senate to redress an injustice that the government has inflicted upon the nation's dental health professionals. This bill requires the Minister for Health, in conjunction with others ministers as may be necessary, 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 the minister can take to redress those inequities. It establishes a timeframe in which action is to be taken and requires a report to be tabled in both Houses of parliament detailing the actions that have been taken.

The Medicare Chronic Disease Dental Scheme was introduced by the coalition in government in 2007 and has been a highly successful scheme in addressing the chronic dental needs of countless Australians. It provided and still provides up to $4,250 in Medicare dental benefits over two years for eligible patients with a chronic health condition. Over 17 million badly needed services have been provided to approximately one million patients since 2007. These services, which have greatly improved the overall health of the recipient patients, are ones that, in the majority of cases, the patients would not have been able to privately fund themselves.

But I do not stand in this chamber today to espouse the virtues of this scheme; those virtues are self-explanatory. Instead, I rise to highlight to this chamber the Machiavellian tactics used by the Labor government to try to close down this worthwhile dental program. Labor have repeatedly tried to shut down this scheme for their own political purposes. Those on the other side of the chamber cannot bear it that the coalition is the only political party in this place to demonstrate and actually deliver on a commitment to a Medicare dental scheme. As they have shown us on many occasions, they are more than happy to forgo good policy outcomes for their own political gain. They particularly hate the fact that this scheme, supporting patients right across Australia to have their chronic dental issues addressed, was introduced by Mr Tony Abbott.

Not able to respect the decision of the Senate when their attempts to close the scheme were rejected, Labor commenced an underhand crusade to undermine the scheme with the establishment of an audit taskforce in June 2010. The coalition strongly supports a transparent and appropriate audit process to detect cases of fraud, the misuse of taxpayer's funds or the provision of inappropriate services. But we do not support Labor's tactic of using innocent and inadvertent administrative errors as a means to claw back funds from dentists, presumably to assist the government in their unattainable quest to achieve a budget surplus—something they have not done for over 20 years!

Upon commencing the audit process, officers from Medicare identified that many dentists had failed to comply with section 10 requirements of the scheme. Under section 10, dental practitioners were required to provide the patient's referring general practitioner with a dental treatment plan prior to undertaking any work on the patient. However, primarily due to a lack of education on those requirements, many dentists were unaware of their administrative obligations and commenced treatment on the first appointment with a new patient prior to providing the necessary paper work to the GP. Treating the oral health needs of a patient prior to fulfilling the administrative requirements of the scheme does not constitute fraud.

In the very common case just mentioned, the timing of the completion of paper work has no impact on patient care or financial outcomes. In the overwhelming majority of cases, the dentists who were caught by the audit process had provided legitimate care to patients in need, entirely in accordance with the terms of the scheme, but for minor and incidental technical requirements of the paper work they were pulled up. Additionally, many dentists worked quickly to rectify their noncompliance as soon as they realised that they were not compliant. Investigating Medicare compliance officers have in some cases recommended that an educational letter be sent to the dentist with no further action taken. But even in those circumstances dentists have still received demands from Medicare for repayments.

This is the case with Tasmanian dentist Wilma Johnson. The case of Dr Johnson was in fact what first peaked my interest in this scheme and the approach the government have been taking to it. Senator Eric Abetz and I have been working very closely with Dr Johnson ever since to try to resolve these issues. Dr Johnson first contacted me last year after she received a demand letter for over $24,000. Initially approached by Medicare for what was termed 'information gathering purposes', Dr Johnson wilfully cooperated, particularly as she was told by Medicare officials that it was nothing more than a 'PR exercise'. When Medicare officials determined that she had been noncompliant in relation to section 10 they immediately began an audit of her previous two years of practice.

Dr Johnson is a highly regarded dental practitioner who is more motivated to work for the public benefit than for her own financial reward. She often works under various programs targeted at improving the oral health of people of low socioeconomic status or with limited access to adequate dental care. At the time she was audited for her work under the Chronic Disease Dental Scheme, she was operating out of what is essentially a rural practice in the Huon Valley region in Tasmania. The Huon Valley has a significant low socioeconomic population, and it is notoriously difficult to attract health professionals of any kind, but especially dentists, to this region.

Additionally, she delivered the services as a part-time employee dentist at this practice and, because she was billed directly the full amount involved, the $24,000—the full amount that was paid under the CDDS—she has been ordered to pay back is three times the amount that she actually received as an employed dentist. Understandably, this situation has proved to be extremely stressful for Dr Johnson. The substantial debt hanging over her head, in addition to her reputation being called into question, has caused her to suffer undue amounts of anxiety and stress and is of great concern to her.

In submissions to the inquiry many other dentists have outlined their frustration with the chaotic manner in which their audits were undertaken. Dentists were sent a letter demanding the provision of 20 files to Medicare within a tight timeframe, but then experienced long delays, often in excess of 12 months, before receiving any response or advice on the outcome of their audit. One submission from a dentist claims that Medicare found the result of his initial audit of 20 patients to be inconclusive and therefore requested an audit of 700 files. One cannot even begin to fathom why Medicare deemed it necessary to audit a whopping 680 additional files in this instance. But we can only conclude that the resources required for that practice to provide the department with the requested information would have proven to be a significant administrative burden and essentially got in the way of the job of treating patients. Other dentists have complained that Medicare was largely inconsistent in its advice to the profession when inquiries were made. Dentists submitted to the committee that, often, two separate phone calls to Medicare in relation to what they needed to do to comply with the administrative requirements of the scheme would result in two different sets of advice, with many dentists even claiming that Medicare had told them directly that they were not required to do anything other than call Medicare to check on a patient's eligibility for the scheme.

It has been suggested—and not convincingly rebutted by the department or the government—that upon winning the 2007 election, at which time the scheme had only just commenced, Labor decided not to take any of the normal steps to ensure dentists were properly educated in what to do to comply with the administrative requirements, such as training front-line staff to teach dentists, as they intended to close the scheme down as soon as possible and so determined that that education would be redundant. Now, 4½ years later, the scheme is still running. For the first few years, dentists were largely flying blind on admin requirements because the government did not do what was necessary to properly train and educate them in these.

To then use the extraordinarily high level of noncompliance with these minor technical administrative requirements to seek to undermine the scheme and, in the process, vilify good dentists, is appalling. It is not surprising that Dr Johnson and many of her colleagues have withdrawn from the scheme, resulting in diminished access to quality dental care for the hundreds of thousands of patients who sought dental treatment under the provisions of this program. Of course, this is just the outcome that Labor was looking for.

Dr John Wilkins, a GP in Huonville in Tasmania, where Dr Johnson practised, wrote in a submission to the committee inquiry:

The dentists who have accepted my referrals have the reputation for kindness and humanity, care for the underprivileged and putting the needs of the needy ahead of the rest. The punitive outcomes of participation in this scheme has damaged dentist who deserve medals, not mental anguish.

Because of the negative outcomes from this outrageous Medicare backlash … I am now unable to access adequate dental care for many of my most severely compromised patients. This is a disaster.

As that submission highlights, it is the patients who are now suffering as a result of this government's desperate cash grab, because this program largely assists the types of individuals who would ordinarily fall through the cracks.

Labor might not like to admit it, but this scheme has given almost a million people a new lease on life through improved dental care, with some people obtaining the best and most comprehensive dental treatment they have ever received in their lives. In some cases, the dentists were first to admit that they faced serious and at times unpleasant challenges by opening their doors and undertaking this community service, at a reduced rate, for less than the fee payable under the scheme, so that those people who for a variety of reasons found themselves in dire need of oral healthcare treatment could get that treatment.

Across the country, 12,000 dental service providers agreed to participate in the program. Yet, now, my office receives regular phone calls from disgruntled and concerned community groups and constituents who have discovered that their dentist has ceased to operate under the program. This has left many thousands of patients across the country stranded. Many may be halfway through their treatment program, only to discover that their dentist will not be able to complete the dental work they require because they no longer feel safe operating under the scheme.

Dr Johnson tells me that, since she has withdrawn from the scheme, she is extremely limited in the services she can offer her chronic disease dental patients. She has provided me with photos of patients on her books in their mid- to late-20s who have had to have all of their teeth extracted. Under the chronic disease dental scheme, Dr Johnson would have been able to extract the rotten teeth and provide the patients with dentures but, now, all she can do is extract their teeth, at a heavily discounted rate, and send them to the state government run dental service, where it is likely they will endure at least a 12-month waiting list to receive dentures. So they have to spend that waiting time without teeth. I do not think anyone on either side of this chamber would have even contemplated being forced into such a situation during their twenties, or in fact at any other time in their life. The impact of this on patients' mental and physical health is significant. This is the consequence of Labor's money grab from the dentists participating in the scheme.

Over 400 submissions were made to the Finance and Public Administration Committee inquiry into this bill and, let me tell you, they paint a very bleak picture. The government would have us believe that the submissions were all from corrupt and greedy dentists. To the contrary, the submissions were from a range of people in the community. The committee received submissions from administrative staff working in dental practices concerned about the impact the audit process was having on workplace morale and the very real possibility that they might lose their jobs. Many patients who had been treated under the program also wrote submissions in praise of the treatment that they had received and of their concern in relation to the penalties the dentists who provided their treatment now face. One patient wrote:

Dr. Mustafa has provided me with strategies to improve my overall dental health associated with diabetes. I might add here that if such dental treatment wasn't carried out, I and thousands of other people in similar situations would become a huge burden on government resources. We should give credit and thank such care providing professionals rather than penalizing them for possible minor administrative errors.

There are submissions from the spouses of dentists, airing their concerns in relation to the mental health and wellbeing of their partners, who in many cases have suffered undue stress as a result of this audit process. They wrote of the detrimental impact this is having on their home and family life. One such submission, from Mrs Marina Donnellan, the practice manager for her husband's dental practice, read:

He did not do anything to deserve this situation and those people driving this unjust witch-hunt should be ashamed of themselves. It is a smear on the face of our Government.

I am worried about the implications all this will have on my family. If our business suffers the damage will be far reaching affecting my children, our employees, our business associates and their families.

So far-reaching is the impact on these dentists that extended family members of dentists were also compelled to write submissions. One father of a dentist wrote:

It is very severe punishment to reclaim back money for services that have been provided, without consideration for the hard work that has gone into it. It also overlooks the expenditure involved in providing these services, which are high out of pocket expenses.

… … …

It is a tragedy that the government can impose such measures on hard-working professionals, especially in a country like Australia, which supposedly prides itself in being a democratic and just country.

After working so hard to provide dental services to a needy population, he has been made to feel like a criminal and a scapegoat for a political money retrieval system.

And of course there were a huge number of submissions from dentists outlining their frustration and anguish over the unjust auditing process they were subjected to by this government. Dr Susan Ravida wrote:

I feel like Medicare has set a trap for me to provide treatment for free in their name. I think it is common sense that if I provide a service, I deserve to get payment for that service. I did not cheat the system or do anything wrong.

Another dentist said:

Medicare did not reply to my 20 patient self assessment submission for over one year. I received a phone call from Medicare on the 16th February 2012. This left me for one whole year feeling apprehensive, stressed, worried and completely uncertain as to what was going on.

That was Dr Angy Yoannidis. Dr Craig Swift said:

I believe it is important to differentiate the treatment of dentists who have abused the system from dentists who have committed minor administrative oversights. There is a big difference between dentists who have acted dishonestly for their own financial gain, and those who have acted in good faith for their patients' well being. This difference should be reflected in any penalties imposed.

The quotes I read to you today are real quotes from the submissions of real people whose lives have been turned upside down as a result of this government's disgraceful witch-hunt. This government has wrongfully called into question the reputations of hundreds of dentists across the country over a number of years.

Finally last month Minister Kim was effectively shamed into a backflip after months of pressure from the coalition—

Senator Moore: Madam Acting Deputy President, I rise on a point of a order. I draw to the attention of the senator that it would be useful if he named the minister correctly in his speech. Just check the Hansard. He actually did not name him.

Senator BUSHBY: Minister Kim Carr.

Senator Moore: You did not say 'Carr'.

Senator BUSHBY: Finally last month Minister Kim Carr was effectively shamed into a backflip after months of pressure from the coalition and the Greens—and I acknowledge that Senator Di Natale, who will be speaking after me, has also taken up the injustice behind these demands. It took every play on the field—numerous media releases, press conferences, letters to the minister, questions at estimates, questions on notice, an inquiry and this private member's bill—for this government to finally concede that retrospective changes are required to the legislation and that maybe some of the dentists involved are being treated unfairly.

And how did Minister Carr decide to make this announcement? After years of tension between government and the dental sector, after years of stress, anxiety and worry placed on dental professionals, Minister Carr decided to announce his backflip in a statement tabled to the Community Affairs Legislation Committee at budget estimates last month, so that affected dentists and stakeholders could read the news in the Age, the Sydney Morning Herald or even the Hobart Mercury over their breakfast the next day.

I will take the opportunity to add here that the announcement was neither gracious nor sincere, with accusations from Minister Kim Carr still flying throughout the estimates period in relation to alleged fraudulent activity undertaken by dentists. It is a totally and utterly disgraceful way for this government to treat a profession that has already been deliberately vilified to suit Labor's own political ends, and it leaves Minister Kim Carr, Minister Roxon and Minister Plibersek with egg on their faces.

Minister Carr has been surprisingly quiet since his May announcement, which is disappointing, because in the wake of the announcement a few weeks ago I spoke to a number of dentists with whom I have been working on this issue, and for the first time in my dealings with them they sounded optimistic and hopeful, like a huge weight had been lifted off their shoulders. I hope that sense of relief is not misguided, because yet again this government has failed to act. We have not heard or seen anything to suggest that it is willing to act quickly to rectify the legitimate concerns of the dental profession.

The dental profession is highly educated and well respected, and yet over 60 per cent of those dentists who have been audited were found to be noncompliant with the admin requirements for the first few years of the scheme. The government maintains that the education provided was sufficient and that dentists were properly informed of the requirements. If it is right, what explanation is there for the extraordinarily high level of noncompliance? I reject the notion that the dentists were not up to understanding the requirements; they are clearly intelligent people. I reject the notion that 60 per cent of participating dentists wilfully ignored the requirements; the percentage is too high for what is generally regarded as a highly honest and very professional group of people.

So what other explanation is there? I cannot think of one, and that brings me back to the assertion by the department that dentists were properly educated and trained on how to use the scheme and the compliance requirements. The only possible conclusion I can draw from the high levels of noncompliance within this program is a failure by the government to adequately educate the profession—and do not forget that dentists are not like doctors, who regularly interact with Medicare. Prior to this scheme, dentists had no relationship with Medicare; the closest was a scheme designed to help veterans, and the requirements of that scheme imposed nothing like the obligations that dentists now have to comply with under the CDDS. In essence, I think dentists have been the meat in the sandwich, and this bill is designed to relieve the pressure that has been unfairly placed upon them.