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Monday, 23 November 2009
Page: 8594

Senator SCULLION (6:07 PM) —I seek leave to move opposition amendments (3) to (6) on sheet 5987 together.

Senator Siewert —I am willing to agree to leave as long as the questions are put separately. I indicate that I will be voting differently on different amendments.

The CHAIRMAN —I can put the questions separately by request.

Leave granted.

Senator SCULLION —I move:

(3)    Schedule 1, item 2, page 4 (line 14), omit “request”, substitute “written request”.

(4)    Schedule 1, item 2, page 5 (after line 19), after paragraph 129AAD(8)(b), insert:

            (ba)    specify the information relevant to ascertaining whether amounts paid in respect of each such service should have been paid; and

(5)    Schedule 1, item 2, page 5 (after line 31), at the end of subsection 129AAD(8), add:

         Note:    For the purpose of paragraph (8)(ba) the notice will include the reason for the CEO’s concern about the payment and explain the factual issue that the person is required to substantiate.

(6)    Schedule 1, item 2, page 6 (after line 7), at the end of section 129AAD, add:

       (11)    Notices to produce documents issued under this section will not include requests for information about whether a particular service was clinically relevant.

Minister, when you rose a moment ago you indicated that there was perhaps some agreement about some words in amendment (6). My feeling is that, after having as much of a look in these circumstances as I can, we had agreed to that. I understood that there was some change of wording and that we had agreed to. I was hoping that perhaps one of my minders could sneak across and sort of check on that. I do not think that that is a problem. In fact, since you have stood and spoken to most of those, as I understand it it was only the review of decisions to claim amounts as debts that was the problem. The reason that I am speaking briefly to that is so that if people who are giving us some assistance want to clarify that while we are discussing amendments (3) to (6) that might be very useful.

Amendments (3) to (6) are about notices to produce documents. Prior to the CEO of Medicare issuing a notice to produce documents that may contain health information within the meaning of the Privacy Act, the CEO of Medicare must first provide an opportunity for the medical provider or the authorised entity to respond to a written audit. This is just part of a process to ensure that we are articulating every opportunity for providers to voluntarily provide information to Medicare.

We initially tried to exclude all documents that might be covered under the Privacy Act from being requested by a Medicare audit. Unfortunately, we were informed—rightly, and thanks to the government for the assistance—that that would probably invalidate the audit process. So this amendment essentially inserts an additional step in the audit process. Upon establishing a reasonable concern—in other words, it is not a random audit—about a provider’s Medicare claim, the CEO of Medicare must allow the provider sufficient opportunity to respond to a written request for factual substantiating evidence as identified through the consultative process outlined in the amendment that I have just spoken of. In time, that will obviously get better, because the provider will understand what they are providing and Medicare will know that they have agreement about some factual processes that are being requested. The CEO of Medicare can only issue a notice to produce documents, including patient health records, if the issue remains unresolved through the supply of factual information.

The second part of that amendment says that any notice to produce documents issued by the CEO of Medicare must specify both the claims that are being audited as well as the factual information required to substantiate the notice request. This amendment will require Medicare to clearly identify what issues are being investigated and what specific information is required to substantiate the claim. Much of the feedback we had was that when people are carrying out an audit, it is often a fishing claim. ‘Just give us all the information you’ve got, and we’ll sort it out.’ We think it is appropriate that they should have to say, ‘These are the claims that we’ve got a problem with and these are the sorts of bits of information that you can provide to us that are going to give us some satisfaction.’ All privacy safeguards introduced through government amendments to the act must be applied to all documents containing patient health records that may be received through the notice to produce documents.