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Payments of Commonwealth nursing home benefits to insured patients in nursing homes



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PAYMENT OF COMMONWEALTH NURSING HOME BENEFITS TO INSURED PATIENTS IN NURSING HOMES

Recent media reports claiming that the Commonwealth had

mistakenly paid large sums to nursing homes throughout

Australia were today described as misleading and sensationalist by the Minister for Health, the Hon.

Michael MacKellar, M.P. .

Mr MacKellar emphasised that the error flowed from incorrect

claims by nursing home proprietors. The amount involved appears to be substantially less than that quoted in newspaper reports.

Mr MacKellar explained that since 1 October 1977 health

funds have been required to pay nursing home fund benefits

to insured nursing home patients at the same rate as

Commonwealth nursing home benefits payable to uninsured .

nursing home patients.

For their part, nursing home proprietors are required to use

all reasonable endeavours to ascertain the insurance status of

patients. Where a proprietor incorrectly submits to the

Commonwealth a claim for nursing home benefits in respect of an

insured patient, the Government is entitled to recover the

money incorrectly claimed. In such a situation the proprietor is entitled to submit a claim to that patient's health

insurance fund for the payment of benefits.

Mr MacKellar said that a Departmental survey of several

nursing homes in one State in early 1980 showed that

Commonwealth nursing home benefits had been claimed by

proprietors and paid in respect of a number of insured patients.

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Accordingly, the Department undertook to examine the

situation in other States to determine whether the problem existed elsewhere.

The Minister said that, to date, the audit had been

completed in South Australia where incorrect claims

by nursing home proprietors amount to $1.9 million.

Audits in Queensland and Tasmania were nearing

completion while in Western Australia, New South Wales

and Victoria, the audit was still in the early stages.

In these circumstances, Mr MacKellar said he was not

in a position to say how much on a national basis has been

incorrectly claimed by nursing home proprietors. However, the indications are that it would be substantially below '

the $25 million figure quoted.

Mr MacKellar said hie had directed his Department to take

the necessary steps to recover moneys identified as having been incorrectly claimed by proprietors. In taking

this action, he said, the Department had also been instructed

to take into account the financial circumstances of individual

nursing homes in relation to the timing of the repayments to ensure that recovery action did not jeopardise their viability

The Minister added that the Department had been in.

consultation with proprietors and the registered health

insurance funds about the recovery process. As the audit identified the nursing home proprietors and the funds concerned, the proprietors were being advised to lodge

claims with the relevant funds in order to spread the

load on the funds over a period and to protect their own

cash flow positions.

Mr MacKellar said he would be taking steps to ensure that

health insurance funds met their obligations under the .

National Health Act to pay nursing home benefits in respect

of their insured nursing home patients.

Canberra 17 February 1981 .