A Review into the compliance system which underpins Medicare has found fraud and non-compliance was likely to cost taxpayers $1.5 to $3 billion a year.
Releasing the findings of the Independent Review into Medicare Compliance and Integrity, the Minister for Health and Aged Care, Mark Butler said the Government commissioned health economist, Dr Pradeep Philip to conduct the Review in November last year in response to concerning reports about the potential for widespread Medicare rorting and fraud.
“Dr Philip’s Review makes clear that the overwhelming majority of health practitioners are well meaning and protective of Medicare, and they provide a high level of care to their patients,” Mr Butler said.
“Dr Philip also found no evidence to support the $8 billion figure highlighted in some media reporting,” he said.
“The Review found that the likely cost to Australian taxpayers is $1.5 to $3 billion a year, with a significant part stemming from non-compliance errors rather than premeditated fraud.
“But without concerted action this figure could increase.”
Mr Butler said the Review made it clear that these problems had been a long time in the making.
He said Dr Philip made 23 recommendations, including to: Strengthen the governance model that oversees integrity; Remove the veto power of professional bodies in the selection process of the Director of the Professional Services Review; Amend the legislation underpinning Medicare integrity to ensure it is effective and fit for purpose; and Improve the detection and disruption of fraud and non-compliance.
The Minister said the Review also recommended improving clarity and consistency for health providers, and up-lifting technological and systems capabilities across Medicare.
“The loss of billions of dollars a year in taxpayer money was consistently and repeatedly highlighted to the former Government in no fewer than five separate reviews between 2016 and 2021, by respected bodies like the Australian National Audit Office, Boston Consulting Group, McKinsey and others,” Mr Butler said.
“The Government is considering the recommendations in Dr Philip’s review and will now work closely with health professionals, patients and peak bodies to develop a comprehensive response.”
The Review’s 73-page Independent Review into Medicare Compliance and Integrity can be accessed at this PS News link.
