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Wednesday, 23 May 2018
Page: 4274


Mr HUNT (FlindersMinister for Health) (09:37): I move:

That this bill be now read a second time.

The Health Legislation Amendment (Improved Medicare Compliance and Other Measures) Bill 2018 amends the Health Insurance Act 1973, the Dental Benefits Act 2008, and the National Health Act 1953, to implement measures announced in the 2017 budget to support the integrity of Medicare through improvements to the recovery arrangements for debts owed to the Commonwealth. These changes save $103.8 million over four years for reinvestment in Medicare.

This bill also makes amendments to the Health Insurance Act 1973to clarify that the jurisdiction of the Professional Services Review extends to corporate medical practices which contract rather than employ individual practitioners.

The amendments are supported by the government's compacts with the Australian Medical Association and the Royal Australian College of General Practitioners. I thank them for their help and support in the development of these amendments. These compacts reflect shared principles that support a stronger, sustainable health system, including improved compliance processes to ensure Medicare overpayments are detected and recovered.

Compulsory offsetting and garnishee

While the majority of practitioners—indeed, the overwhelming majority of Australia's extraordinary medical workforce—claim Medicare Benefits Schedule, Pharmaceutical Benefits Scheme and dental benefits absolutely appropriately, a small number of practitioners do not. Amongst this small number, some claim incorrectly. Some are found by the Professional Services Review to have engaged in inappropriate practice or are found to have engaged in fraudulent claiming, and are required to make a repayment to the Commonwealth for incorrect claims.

I repeat and reaffirm that not only do we have an outstanding medical workforce; we have an outstanding degree of integrity amongst that workforce—one of the best, if not the very best, in the world—and this is to deal with the very, very small number of outliers.

However, only some practitioners who have a Medicare debt agree to enter into arrangements to repay that debt. Over $50 million in compliance debt is currently outstanding and some of these debts are worth over $1 million. Those that refuse to agree to a repayment arrangement are currently still able to claim benefits through Medicare, including receiving significant payments directly from the Commonwealth for bulk-billed services.

These amendments will allow for future bulk-billed claims to be reduced or offset by up to 20 per cent, to repay their debt to the Commonwealth—of course, where there has been a proven incorrect claim, whether it is by inadvertence or by intention. For those practitioners who do not bulk-bill, the amendments will allow garnisheeing of other funds owed to the practitioner who holds the debt, including funds held in bank accounts and income from employers. An offset or garnishee arrangement will only apply if all rights for review have expired and the practitioner does not agree to a repayment plan within 90 days. These new arrangements will start on 1 July 2018. Indeed, it is my hope that the very fact of these new arrangements will mean that they do not have to be brought into action.

These changes will ensure that more practitioners repay their debts, allowing this money to be reinvested in new services under the Medicare Benefits Schedule and new listings on the PBS to ensure Medicare continues to provide more support to Australian patients than ever before.

No patients will be affected by these changes. This was a fundamental principle both of the government and of the AMA and the Royal Australian College of General Practitioners. Where practitioners engage in inappropriate practice, or claim incorrectly, they are responsible for the repayment of any excess Medicare payments, even if the rebate was paid directly to the patient or the person who incurred the expense on their behalf.

Improving the consistency of administrative arrangements across the three acts

These amendments will reduce inconsistencies in record-keeping requirements among different professional groups.

For the first time, allied health practitioners will face the same rules as doctors and be required to keep copies of referral documents for two years, and all practitioners will be required to keep copies of documents that were created as a condition of claiming the item.

The bill also addresses an anomaly where pharmacists are required to keep copies of prescriptions but not to produce them to substantiate claims.

Amendments will also apply compulsory administrative penalties on unpaid debts to dentists and pharmacists so they are treated the same as other Medicare practitioners.

These changes will ensure that instances of suspected incorrect billing can be investigated properly and any overpayments can be identified. Anything claimed back will be reinvested as part of the increase of Medicare funding from approximately $25 billion to $26 billion to $27 billion to almost $29 billion over the course of the forward estimates on a per annum basis.

Professional Services Review

The Professional Services Review currently is able to review officers of organisations based on their influence over their employees' billing practices. Practitioners are increasingly employed as contractors. These amendments clarify that the jurisdiction of the PSR extends to officers of organisations that engage Medicare practitioners as contractors.

Organisational billing

The current legislation places all of the liability for Medicare claiming against an individual practitioner, except in clear cases of fraud. This reflects the old business model of single-doctor practices. However, in contemporary practice there has been an increase in the role of practices, corporate entities and hospitals in the billing of MBS services on behalf of individual practitioners.

The amendments will introduce a scheme where, if there is an employment or other contractual relationship, the practitioner and their employer (or other related party) will each be responsible for the repayment of part of the compliance debt.

This change represents a significant shift, moving to a fairer distribution of the responsibility for getting billing right, and is supported by key stakeholders, including the AMA and the Royal Australian College of General Practitioners, and again I thank them for their cooperation not just on the principle but also on the fine detail of implementation.

These new shared debt recovery arrangements will start on 1 July 2019. This will allow further time for consultation on the detail of the proportions to apply to the practitioner and employing or contracting organisation, which will be set out in regulations.

Ultimately, this follows from the government's agreements with the sector. This change has been strongly supported by the medical sector because it ensures that the vast bulk, the overwhelming majority, of extraordinarily capable Australian doctors and the medical workforce will be supported and that the very, very small number who have done the wrong thing, either inadvertently or intentionally, will have the responsibility to make redress. At the end of the day, though, what we are doing is ensuring that there is a long-term absolute guarantee about the future of Medicare and the PBS. I commend the bill to the House.

Debate adjourned.