By Adele Ferguson and Chris Gillett
Rorting Medicare has become so lucrative that courses teach doctors and health professionals how to milk the $28 billion taxpayer-funded billing system and cover their tracks.
Offering carefully worded courses and conferences, some operators market themselves as experts in educating health professionals on how to get the most out of the 5800 services eligible for a Medicare rebate.
Rorting Medicare has become so lucrative, there are courses that teach medical professionals how to milk the system.Credit: iStock
A joint investigation by The Sydney Morning Herald, The Age and ABC’s 7.30 has uncovered flaws in Medicare’s systems that make it easy to rort and almost impossible to detect fraud, incorrect payments and errors.
The investigation has also obtained access to teaching materials from an online course that offers doctors step-by-step guides on how to maximise returns and promotes the practices as legal and ethical.
The lecturer explains to doctors how to “pack and stack” Medicare by loading a combination of Medicare billings onto each patient while they are in front of the practitioner. In addition, they encourage repeated returns of the patients for more services.
“It’s about return of service, OK?” the lecturer says. “We have a tendency to just be like, ‘You come to me, I do something for you and then I wait for you to come back’ … we’re trying to engage patients to get them to come back.”
The suggestion is to create a business model to maximise revenue, including setting patient targets for Medicare services. The more services secured, the more rebates are given.
“By utilising and knowing the numbers in the Medicare Benefits Scheme, you encourage people to come back, OK?” the lecturer says. “In our clinic, we do have a target, not a specific target. But we do try to when a patient leaves the clinic … we try and get them to specifically make a plan to come back.”
She lists the type of services a GP can claim for a patient such as care plans, health assessments, medication reviews and nurse reviews, all which “maximise rebates”.
To claim more, the lecturer suggests breaking up consultation visits into more than one visit, but the practice is framed as the GPs caring for their patients.
“What is really essential is that if you are bulk-billing patients, to be able to get them to come back so that you keep seeing patients and you get to care for them,” the lecturer advises.
Dr Margaret Faux, the country’s leading expert on Medicare, was shown the online course and said she was appalled but not surprised.
“It’s all about gaming the system and milking Medicare to get as much out of it as you can,” Faux said.
Margaret Faux estimates incorrect payments and errors represent nearly 30 per cent of Medicare’s annual budget. Credit: Janie Barrett
Faux has estimated leakage from fraud, incorrect payments and errors represent nearly 30 per cent of Medicare’s annual budget, or about $8 billion a year.
The Hawke government established Medicare in 1984 as a universal health system paid for by taxpayers through a levy that provides free or subsidised healthcare services to Australians.
It was set up as an honour system with the hope that doctors would bill correctly for the service provided.
However, armed with a patient’s name, date of birth and Medicare number, health practitioners can log into the portal and bulk-bill anything and patients are often none the wiser.
Dr Tony Webber, a GP and former head of the Medicare regulator, the Professional Services Review, said rorting had occurred for decades.
Watch the ABC’s 7.30 program on Monday, October 17 for more.
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