Surgeons' billing questioned by secret TAC audit

A SECRET Transport Accident Commission audit of The Alfred hospital reveals surgeons may have billed the TAC for treating patients they had not actually seen.

The 2007 TAC draft audit also asks why the commission is pumping millions of dollars it receives from Victorian drivers into hospital services that are already taxpayer-funded.

The release of the audit under the Freedom of Information Act comes amid continuing controversy over the suspension of The Alfred's trauma director, Thomas Kossmann, who is being investigated by a medical panel over allegations that he performed unnecessary surgery on patients and wrongly billed the TAC. He has rejected the allegations.

The identities of two doctors named in the audit were removed from the documents, but The Age has confirmed Professor Kossmann is one of the doctors named. It has been reported that The Alfred received a percentage, possibly as much as 50%, from each of his TAC billings.

Written by the deputy of the TAC's clinical panel, David Bolzonello, the audit found irregular note-keeping in patient files at The Alfred made it impossible to correlate doctors' billing records with patient data.

The February 2007 audit, done without the knowledge of The Alfred, was unable to ascertain if senior doctors who had billed for treating patients had actually seen them or whether more junior doctors — who cannot charge the TAC — had done the work. It concluded: "It is unclear from the notes if this reflected actual review by these people themselves (who submitted bills) or the unit staff such as registrars as I could not see regular entries in the files to correlate the billing."

The TAC pays for the treatment of road accident victims in Victoria through compulsory third-party insurance premiums on motor vehicle registrations.

Several doctors at The Alfred have accused some senior colleagues of billing the TAC for work they have not done.

The disclosure of the audit has renewed pressure on the Brumby Government to review the relationship between the TAC, doctors and public hospitals, with Opposition Leader Ted Baillieu yesterday saying it enhanced his call for a judicial inquiry into the controversy at The Alfred. "There are numerous doctors and public officials involved in this matter and it is imperative that their roles and actions are clarified as soon as possible," he said.

Other issues raised by Dr Bolzonello's audit included:

■A review of the State Government policy governing financial transactions between public hospitals and the TAC. "… The Alfred and its equipment are owned already by the people of Victoria. The resident staff is also paid by public funding. The TAC is then billed at private rates for radiology, pathology and bed fees. There is some argument for review of this."

■A lack of clinical notes to summarise the "management and decision making" of The Alfred's emergency department.

■Queries over whether the use of scans and hospital equipment — for which the TAC could be billed — was excessive.

The TAC took no further action after receiving Dr Bolzonello's audit, which examined 50 patient files and concluded the medical management to be reasonable. His audit did not review individual billings.

A TAC spokesman said the rules governing billing "rely to some degree on the honesty of the individual or organisation submitting the account". Procedures were in place for fraud to be investigated, he said.

A spokeswoman for The Alfred said the hospital had not received any billing complaints from the TAC. "There is a funding system set up by the Department of Human Services and the TAC. We follow the rules and we are no different to other hospitals working in that system."

Professor Kossmann, who is awaiting the final report of a medical panel commissioned by The Alfred to investigate serious allegations against him, said the TAC audit contained nothing to undermine his reputation.

The German-born surgeon was suspended by The Alfred in November due to adverse findings in the panel's draft report. He has challenged his suspension by Bayside Health in the Supreme Court.

Professor Kossmann said he would be happy to work under a more efficient TAC billing system if one could be established. "I'm a surgeon not a policy maker. These issues are for the (TAC) minister and the TAC board."

The final report into the allegations against Professor Kossmann is expected to be released this month.