A Commonwealth Ombudsman investigation into media allegations of Comcare ‘doctor shopping’ as a way to deny or cancel compensation claims has found the Authority unable to easily provide assurance that individual medical examination decisions were appropriate.
In his report Comcare’s management of medical examinations, Ombudsman, Iain Anderson said his investigation was informed by the media covering a story of alleged doctor shopping.
Mr Anderson said the ABC article focused on Comcare’s use of its powers under the Safety, Rehabilitation and Compensation Act 1988 (SRC Act), “including alleged examples where Comcare had reportedly selected certain medical practitioners or sent claimants to multiple medical practitioners to get a report it could use to deny a compensation claim or cancel a claimant’s existing compensation payments – a practice referred to as ‘doctor shopping’”.
“The ABC article also included allegations that some claimants were required to attend medical examinations with medical practitioners who did not have appropriate qualifications, or with practitioners who had been the subject of repeated complaints,” Mr Anderson said.
“We found while Comcare’s procedures and internal guidance are consistent with section 57 of the SRC Act, there are opportunities to strengthen its administrative framework to better support consistent and reasonable decision-making,” he said.
“In particular, there is an opportunity for Comcare to address gaps and inconsistencies in its internal guidance to better support decision-makers to make consistent, reasonable and transparent decisions, as well as strengthen its communication with claimants.”
Mr Anderson said Comcare did not require decision-makers to consistently record the reasons for medical examination decisions.
He said limitations were also found in Comcare’s data capability, “meaning Comcare is unable to quickly retrieve, analyse and report information about its use of medical examinations”.
“Comcare is not well placed to provide assurance that individual medical examination decisions are appropriate, or to monitor how section 57 powers are used across the Agency,” the Ombudsman said.
“As a result, in our view, Comcare cannot quickly and easily provide assurance that its decision-making is appropriate in practice.”
Mr Anderson made nine recommendations to improve Comcare’s administrative framework for the use of its medical examination powers and to strengthen Comcare’s approach to managing related complaints.
The Ombudsman’s 38-page Report can be accessed at this PS News link.
