The top specialist who led Australia’s biggest ever review into Medicare has rubbished suggestions that $8 billion a year is being lost to fraud and errors, saying the figure doesn’t fit with what he saw over five years examining the system in detail.
The message from Professor Bruce Robinson comes after Minister for Health Mark Butler ordered an inquiry into Medicare compliance after media reports on Monday alleging rampant fraud as well as incorrect payments and billing errors by doctors.
Sparking outrage from doctors’ groups, the claim is based on estimates by Dr Margaret Faux (PhD), a researcher and CEO of a medical administration provider called Synapse Medical.
She estimated the leakage at nearly 30% of Medicare’s annual budget, or about $8 billion a year, according to the reports published in the ABC and Nine newspapers.
“The system is being rorted by health professionals, fabricating medical records and billing unnecessary services to boost their profits,” the report said.
“The lack of regulation is staggering and patients’ lives are at risk.”
Dr Faux said her claims were based on “the best available evidence” identified in her PhD thesis on Medicare compliance, adding the $8 billion figure was conservative and “might be higher”.
She also pointed to research undertaken by an academic at the University of Wollongong in 2004 finding up to 25% of Medicare payments could be inappropriate.
“Since then, complexity has increased exponentially and support has decreased to the point where it’s almost non-existent,” she told the media.
“And there’s no controls. We took more controls out of the system so it can only be higher than it was then.”
‘No way’
Professor Bruce Robinson, the endocrinologist behind the MBS Review Taskforce, said he saw nothing while chairing the review from 2015 to 2020 that suggested the system was being abused at anywhere near that scale.
He told the limbic: “When I saw that $8 billion figure, I thought ‘no way actually’. It just seems like too large a number.”
Professor Robinson’s own idea, the review cost millions, involving 700 experts and examining the use of all 5700 items on the MBS.
A former University of Sydney medical dean, he stressed fraud and inappropriate claiming remained real concerns despite the taskforce’s efforts to eliminate outdated or commonly-misused items.
“The goal of the review was to try to tighten up the item descriptors so that fraud was less possible and they were also clearer,” he added.