Mark Butler flags cases of Medicare fraud as department investigates $8 billion claims from system


Health Minister Mark Butler has admitted there was fraud in Australia’s health insurance system in light of allegations of $8 billion from the system.

Mr. Butler ordered a review of Medicare after a joint report published Monday in the ABC and Nine newspapers revealed alleged billing errors, including the number of practitioners falsifying records, billing for services that never had place or billing deceased persons.

Medicare’s existing compliance and audit programs have come under heavy criticism from experts – including Dr Margaret Faux who has completed her doctorate on Medicare compliance – saying it is nearly impossible to detect fraud, incorrect payments or errors.

Mr Butler told the RN Breakfast on Tuesday that a number of cases were being investigated for fraud, with ‘bad apples’ slipping through the system.

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“There is fraud in the Medicare system, unfortunately. I mean, there are over 500 million Medicare services provided every year,” Butler said.

“When you talk about this kind of scale, there will inevitably be a bad apple.”

The Minister of Health confirmed that 24 cases of fraud are currently being considered by the courts, but that the small number of cases were “properly prosecuted”.

Mr Butler agreed with the Australian Medical Association that the number of cases in the report appeared high, with the report claiming 30% of the annual budget had been misused.

“That seems extraordinarily high. I understand the AMA’s reaction to the concept that 30% of consultations are charged inappropriately,” he said.

“Because a figure like that has never been used despite the rather old compliance and auditing systems that governments of both political persuasions have.”

The AMA – the main body representing doctors – launched a scathing attack on the report calling the allegations an “unjustified insult” against the entire medical profession.

WADA President Steve Robson vehemently denied the allegations in a statement on Monday and said the allegations would “sicken” doctors.

“Physicians will be sickened by today’s news reports which are an undeserved attack on the entire profession based largely on anecdotes and individual cases,” Robson said.

“The AMA is working closely with the Department of Health on compliance and we have never seen any concerns or figures that would support the figures reported today.

“We do not condone fraud and instances of fraud must be combated and eradicated – but the figures reported today are grossly inflated.”

Mr Butler was unable to give further details of the review to investigate the misuse of public funds as he feared he would ‘pre-empt’ the assessment.

However, he said his government would take the opportunity to review a crippled GP system and reassure worried Australians.

“Any instances of fraud or misrepresentation – particularly at this time, given the state of crisis in general practice – is going to cause very serious concern among the Australian public,” Mr Butler said.

“This is a timely opportunity for us to take a deep dive into how the audit and compliance system works and ensure that – especially at a time when every dollar going to Medicare is so valuable – that we are getting the most out of it. value for that money.


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