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Tuesday, 6 December 1983
Page: 3345

Question No. 370

Senator Macklin asked the Minister representing the Minister for Health, upon notice, on 21 September 1983:

(1) What action is the Department of Health currently taking in relation to fraud and overservicing following publication of the Joint Parliamentary Committee of Public Accounts Progress Report on Medical Fraud and Overservicing.

(2) Who is in charge of the review of the Medical Services Committee of Inquiry into Overservicing by individual doctors.

(3) What resources is the Department providing from its annual budget to cut back the problem of overservicing.

(4) What co-ordination exists between the committee involved with the implementation of Medicare and the group involved with the fraud and overservicing.

(5) Who are the people currently serving on the Medicare Liaison Committee.

(6) Is the Department now paying benefits to doctors not covered by item numbers as was suggested in evidence provided to the Joint Parliamentary Committee of Public Accounts that there had been a number of changes to the medical benefit schedule; if so:

(a) is this practice accepted in the central office;

(b) is this practice known as the 'pay-under' item number; and

(c) has there been any objection to this practice from health insurance funds.

(7) Has any advice been received by the Department from the Deputy Crown Solicitor in relationship to the legality of this operation; if so:

(a) has any recommendation been made to lay charges against senior public servants in relation to this matter; and

(b) has the Minister for Health been informed of such advice; if so, what action has the Minister taken.

Senator Grimes —The Minister of Health has provided the following answer to the honourable senator's question:

(1) In general terms, the Department is substantially up-grading its activities in relation to medical benefits fraud and overservicing. I made details of this available to Parliament in a Ministerial Statement on 15 November this year.

(2) The most senior Department of Health officer directly involved in a review of measures for dealing with medical overservicing is the First Assistant Director-General, Surveillance and Investigation Division.

(3) The Department has allocated the following resources from its budget for 1983/84 to combat overservicing:



Salaries 1,991,553 Overtime 109,520 Travel 289,200 Office requisites 63, 000 Postage 69,400 Office services 22,700 Vehicles 118,280 Committees 180,000 Advertising 10,000 Freight 2,000 Furniture 34,000 Legal costs 250 ,000

The following additional resources have been allocated for combating the problems of medical benefits fraud and overservicing:



Automatic data processing 1,767,000 Capital equipment 25,000

(4) Such co-ordination is being achieved through the operation of a Medicare Fraud and Overservicing Working Party. This working party is chaired by the First Assistant Director-General, Surveillance and Investigation Division of the Department and comprises officers of relevant divisions within the Department of Health and from the Health Insurance Commission.

(5) There is not, and has not been, a Medicare liaison committee, so named.

A Medicare ministerial advisory group was established in March to advise me on matters of policy. The membership of that group was.

Mr L. Willett (Director-General of Health)

Dr J. Deeble

Dr B. Shea

Dr R. Madden

Dr R. Scotton

Dr S. Sax

Mr R. Williams

That advisory group has been dissolved.

Meetings are currently held on an ad hoc basis with officers of the Health Department, Health Insurance Commission and representatives of the advertising agency to discuss the progress of Medicare's implementation.

(6) (a) Since the inception of the medical benefits scheme in 1953, it has been the practice that, where a patient receives a legitimate medical service not covered by a specific item in the medical benefits schedule, the payment of benefit under the most appropriate existing item will be authorised by the Department.

(b) Yes.

(c) The Department is not aware of any objections to 'pay under' items from health insurance funds.

(7) In giving advice on another matter, the Deputy Crown Solicitor in Perth referred to earlier advice by the Attorney-General's Department on the legality of 'pay under' items.

(a) No.

(b) Yes. I approved a mechanism for paying benefits for legitimate medical services not specifically listed in the medical benefits schedule so that patients receiving such services are not financially disadvantaged. After consultation with the Attorney-General's Department, appropriate changes to the medical benefits schedule were introduced on 1 November 1983.