‘Really disgusting’: Surgeons probed over ‘operating on multiple TAC patients at same time’

An anti-corruption probe into one of the state’s busiest hospitals is examining claims that surgeons charged the Transport Accident Commission for operating on multiple patients at the same time.

This masthead revealed on Sunday that the Independent Broad-based Anti-corruption Commission was investigating a handful of surgeons at the Royal Melbourne Hospital over allegations they billed the TAC for medical procedures never carried out on patients, and fraudulently claimed assistant surgeon fees.

IBAC is investigating claims that surgeons fraudulently billed the TAC.Credit: iStock

Four sources – speaking on the condition of anonymity for fear of reprisal – have revealed that surgeons would simultaneously run multiple theatres, often staffed by registrars, and then claim to the TAC they had operated in all theatres at the same time. This, the sources said, enabled them to attract higher rebates from the public insurer. Registrars are not allowed to charge the TAC.

“The primary surgeon is jumping from one theatre to the next and not being meaningfully involved in the actual surgery but just writing operation reports,” one hospital source said. “They might write these reports from the tearoom. It is really disgusting.”

The government-owned TAC is funded by Victorian motorists to pay for the treatment of road accident victims, and reimburses hospitals, surgeons and anaesthetists for each TAC patient they treat.

Surgeons and anaesthetists bill the TAC for this work in addition to receiving an hourly rate from their hospital, an arrangement insiders say creates a perverse financial incentive for some surgeons to harvest TAC patients.

It can also be revealed that IBAC is looking into concerns that some surgeons at the Parkville hospital cherry-picked lucrative TAC patients, prioritising them over public patients waiting for urgent surgery.

“Some surgeons have monopolised the trauma ... they have gone out of their way to treat TAC cases ... to make sure they are the only ones who bill for it,” said one hospital source, who did not want to be identified for fear of reprisals.

This masthead has seen evidence of one injured TAC patient being moved to a rehabilitation facility before their operation and then transported to the Royal Melbourne Hospital to allegedly coincide with a particular surgeon being rostered on.

A hospital source claimed this was orchestrated to allow the particular surgeon to bill the TAC for the patient’s surgery.

“Everyone knows what happens; they are too frightened to say anything,” another hospital source said.

Health Minister Mary-Anne Thomas.Credit: Nine

On Sunday, Victorian Health Minister Mary-Anne Thomas welcomed the IBAC investigation, saying that while there was no evidence the alleged behaviour was widespread, if the allegations were true that would be “a gross misuse of public funds and breach of trust”.

“If this is true, I’m absolutely devastated. This is a breach of trust with the Victorian people,” she said. “The integrity of our health system is absolutely paramount, and it’s important that Victorians can have the highest trust in our healthcare system.”

Both Thomas and TAC Minister Danny Pearson said they were not aware of the allegations before Friday, despite three hospital sources telling The Age the accusations were the worst-kept secret among Melbourne’s medical community.

Thomas said there was no reason to believe the TAC incentives gave surgeons and anaesthetists the opportunity to abuse the state’s system.

Pearson told media he would not comment on an ongoing investigation other than to say he had not been aware of the allegations until he read about them in this masthead.

“I think it’s appropriate that that investigation be allowed to run its course without providing a running commentary,” he said.

Opposition health spokeswoman Georgie Crozier called on IBAC to release its findings and said she believed the alleged scam was costing taxpayers tens of thousands of dollars a day.

“These allegations were reported to the TAC years ago, reported to IBAC years ago, reported to the Royal Melbourne Hospital executive years ago,” she said.

Credit: Paul Harris

“Victorians deserve better than a health system that is mired in corruption and scandals like this … we’ve got corruption rorting in one of Victoria’s largest and most prominent hospitals – and it’s just not acceptable.”

Crozier said the relevant ministers should be stepping in to resolve these issues.

While the exact scale of the IBAC investigation is unknown, medical fraud and compliance expert Dr Margaret Faux said better technology was needed to crack down on incorrect claims.

While the TAC has adopted the Medicare Benefits Schedule items, definitions and rules for services provided by medical practitioners, Faux said it did not have a rigorous system to interrogate claims.

“As soon as they have a TAC number, it is open slather,” said Faux, who runs a company that processes medical bills for doctors and hospitals. “They do as many things as they can to these patients because they are cash cows.”

A recent hospital patient, who did not receive treatment at the Royal Melbourne, contacted The Age after reading about the claims and agreed that the system was open to “all kinds of manipulation”.

The Victorian resident, who requested anonymity, said that after managing to check their surgery item numbers, they were surprised by how many there were.

“What other business transaction can be made without the receiver seeing an account?”

A Royal Melbourne Hospital spokesperson said the health service upheld strict governance and was proud to deliver exceptional care.

Both IBAC and the TAC have said it would be inappropriate to comment on an any investigation.

The TAC finalised 14 prosecutions last financial year, resulting in $484,124 in restitution payments for the public insurer. Thirty warning letters were sent over the same period in cases that did not meet the prosecution threshold.

With Selina Zhang

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