Doctors cannot close their eyes to the fraud that takes place within their profession, says top medic Dr Nick Coatsworth.
An explosive investigation by the Sydney Morning Herald and the ABC on Monday claimed that an estimated $8 billion a year is siphoned off Medicare by doctors charging for services they failed to provide or overburdening patients.
Extreme cases have involved a primary care physician who billed dead people in a retirement home, a dentist who exposed children to radiation for unnecessary procedures, and doctors who misdiagnosed conditions such as diabetes to claim a higher Medicare discount.
dr. Nick Coatsworth has responded to claims of mass looting of Medicare by saying it’s a simple matter for doctors to cheat the system
dr. However, Coatsworth said fraud would occur every time a doctor bills taxpayers for a complicated consultation, when it is actually a simple consultation.
“Very interesting reactions to the misuse of the Medicare fund article today, especially strong reactions to the use of the word ‘fraud,'” tweeted Dr. Coatsworth.
In a series of tweets, Dr. Coatsworth that while there were many hardworking and honest doctors, that didn’t mean the problem didn’t exist
‘Unfortunately, it’s that simple. If we bill a complex consultation when it was a simple consultation [one]it’s fraud.’
Top doctors, the Australian Medical Association (AMA), on Monday reacted furiously to claims of widespread Medicare rotting, which they called “an unwarranted blot on the medical profession.”
“The AMA is working closely with the Department of Health on compliance and we’ve never seen any concerns or numbers that would support the numbers reported today,” said AMA President Professor Steve Robson.
“Doctors will be sickened by today’s coverage, which is an unjustified attack on the entire profession, based heavily on anecdotes and individual cases.”
dr. Coatsworth, who is a former deputy medical director, agreed that “there will be hard-working clinicians who will find the article offensive,” but that did not negate the allegations.
Medicare loses $8 billion a year to fraud and misdiagnosis, according to a new report
“However, we have to admit that it is very likely that there is overservice, excessive billing and that policing is only getting the tip of the iceberg,” he said.
“Obviously, only a small minority of doctors would bill deceased patients. However, I’d like us to address the problem rather than act as if it doesn’t exist.’
On the 7:30 p.m. ABC current affairs program, Dr. Austin Sterne, one of the founders of the Southeast Queensland ‘Superclinic’ Tweed for Health, detailed shocking allegations of alleged medical malpractice at his former workplace.
Dr Austin Sterne, co-founder of a so-called super clinic in southeastern Queensland, claimed that fraud was rife in his former workplace, claiming that a practitioner had even misdiagnosed people with diabetes in order to claim more Medicare money
“There was falsification of patient records,” he said.
“Medicare was billed for services that were not delivered and there was also overservice.”
‘A specific practitioner in the clinic was diagnosing patients with diabetes when they did not have diabetes.
“They may have had pre-diabetes, but that’s not diabetes because if a patient is diagnosed with diabetes, there’s an additional Medicare part number and a reimbursement that has to be paid for every patient you have with type 2 diabetes.”
AMA President Professor Steve Robson has called the Medicare report rorting an “undeserved attack on the entire profession, based heavily on anecdotes and individual cases”
He also said patients were billed to Medicare for being seen twice in the same day “once in the morning, once in the afternoon” and sometimes billed if no patients were seen at all.
dr. Sterne said he was forced to resign from the clinic because he was trying to stop the alleged fraudulent practices.
The ABC noted that the clinic is now under new management.
Medicare compliance expert and auditor Margaret Faux said the incentives were there to cheat the system.
It is estimated that nearly a third of Medicare’s budget is being swallowed up by doctors doing the wrong things
“I think most Australians believe that doctors are honest people,” Faux said.
“But the reality is wherever you have a huge pot of money that is super easy to access, you get bad actors building business models and taking the money illegally.”
dr. Faux estimates that $8 billion a year is lost to physicians over-demanding, which is nearly a third of the program’s total budget.
That figure was supported by Dr. Tony Webber, who led the Medicare regulator’s Professional Services Review.
He said that when doctors were caught straining, they sometimes offered the excuse, “Well, everyone does it, why shouldn’t I?”