Union says 'billions down the drain' in Medicare fraud
The union's calculations are based on previous analyses, such as the government-commissioned Independent Review of Medicare Integrity and Compliance in 2023.
They estimated fraud and non-compliance rates to range from five-to-30 per cent with a maximum $10 billion cited as a figure that "cannot be definitively disproven, because there is no effective system to measure fraud and non-compliant billing in the first place".
In a report published on Wednesday, the union found about 60 per cent of medical professionals referred to Professional Services Review (PSR), which investigates cases of Medicare-related "inappropriate practices", in 2024 were GPs.
"Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said.
"It's got to stop. Government and regulators have to hold people to account."
"This is public money. Medicare has to be delivering for all of the community not just a certain few."
The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements.
Nearly two thirds of PSR case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers.
AAP has sought comment from the Royal Australian College of General Practitioners about the union's findings.
The union, which represents more than 50,000 members across public and private hospitals as well as in other sectors such aged care and pathology, also surveyed 110 healthcare workers in billing, finance, and compliance.
Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims.
One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud.
Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation.
The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight.
"Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published Wednesday said.
The AMA has been contacted for comment."Every dollar lost to Medicare fraud is a dollar taken from hospitals and the most vulnerable Australians who rely on our public health system," Mr Hayes said.
AAP has approached federal Health Minister Mark Butler for comment.
Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, adding up to billions being wasted yearly, the Health Service Union says.
The union's calculations are based on previous analyses, such as the government-commissioned Independent Review of Medicare Integrity and Compliance in 2023.
They estimated fraud and non-compliance rates to range from five-to-30 per cent with a maximum $10 billion cited as a figure that "cannot be definitively disproven, because there is no effective system to measure fraud and non-compliant billing in the first place".
In a report published on Wednesday, the union found about 60 per cent of medical professionals referred to Professional Services Review (PSR), which investigates cases of Medicare-related "inappropriate practices", in 2024 were GPs.
"Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said.
"It's got to stop. Government and regulators have to hold people to account."
"This is public money. Medicare has to be delivering for all of the community not just a certain few."
The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements.
Nearly two thirds of PSR case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers.
AAP has sought comment from the Royal Australian College of General Practitioners about the union's findings.
The union, which represents more than 50,000 members across public and private hospitals as well as in other sectors such aged care and pathology, also surveyed 110 healthcare workers in billing, finance, and compliance.
Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims.
One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud.
Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation.
The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight.
"Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published Wednesday said.
The AMA has been contacted for comment."Every dollar lost to Medicare fraud is a dollar taken from hospitals and the most vulnerable Australians who rely on our public health system," Mr Hayes said.
AAP has approached federal Health Minister Mark Butler for comment.
Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, adding up to billions being wasted yearly, the Health Service Union says.
The union's calculations are based on previous analyses, such as the government-commissioned Independent Review of Medicare Integrity and Compliance in 2023.
They estimated fraud and non-compliance rates to range from five-to-30 per cent with a maximum $10 billion cited as a figure that "cannot be definitively disproven, because there is no effective system to measure fraud and non-compliant billing in the first place".
In a report published on Wednesday, the union found about 60 per cent of medical professionals referred to Professional Services Review (PSR), which investigates cases of Medicare-related "inappropriate practices", in 2024 were GPs.
"Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said.
"It's got to stop. Government and regulators have to hold people to account."
"This is public money. Medicare has to be delivering for all of the community not just a certain few."
The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements.
Nearly two thirds of PSR case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers.
AAP has sought comment from the Royal Australian College of General Practitioners about the union's findings.
The union, which represents more than 50,000 members across public and private hospitals as well as in other sectors such aged care and pathology, also surveyed 110 healthcare workers in billing, finance, and compliance.
Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims.
One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud.
Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation.
The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight.
"Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published Wednesday said.
The AMA has been contacted for comment."Every dollar lost to Medicare fraud is a dollar taken from hospitals and the most vulnerable Australians who rely on our public health system," Mr Hayes said.
AAP has approached federal Health Minister Mark Butler for comment.
Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, adding up to billions being wasted yearly, the Health Service Union says.
The union's calculations are based on previous analyses, such as the government-commissioned Independent Review of Medicare Integrity and Compliance in 2023.
They estimated fraud and non-compliance rates to range from five-to-30 per cent with a maximum $10 billion cited as a figure that "cannot be definitively disproven, because there is no effective system to measure fraud and non-compliant billing in the first place".
In a report published on Wednesday, the union found about 60 per cent of medical professionals referred to Professional Services Review (PSR), which investigates cases of Medicare-related "inappropriate practices", in 2024 were GPs.
"Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said.
"It's got to stop. Government and regulators have to hold people to account."
"This is public money. Medicare has to be delivering for all of the community not just a certain few."
The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements.
Nearly two thirds of PSR case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers.
AAP has sought comment from the Royal Australian College of General Practitioners about the union's findings.
The union, which represents more than 50,000 members across public and private hospitals as well as in other sectors such aged care and pathology, also surveyed 110 healthcare workers in billing, finance, and compliance.
Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims.
One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud.
Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation.
The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight.
"Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published Wednesday said.
The AMA has been contacted for comment."Every dollar lost to Medicare fraud is a dollar taken from hospitals and the most vulnerable Australians who rely on our public health system," Mr Hayes said.
AAP has approached federal Health Minister Mark Butler for comment.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Perth Now
11 hours ago
- Perth Now
Hundreds of killings near Gaza aid sites, convoys: UN
The UN human rights office has recorded 613 killings near humanitarian convoys and at aid distribution points in Gaza run by an Israeli-backed American organisation since it began operations in late May. Spokeswoman Ravina Shamdasani said the rights office was not able to attribute responsibility for the killings. But she said "it is clear that the Israeli military has shelled and shot at Palestinians trying to reach the distribution points" operated by the Gaza Humanitarian Foundation (GHF). She said it was not immediately clear how many of those killings had taken place at GHF sites, and how many occurred near convoys. Speaking to reporters at a regular briefing, Shamdasani said the figures covered the period from May 27 to June 27, and "there have been further incidents" since then. She said she was basing the information on an internal situation report at the office of the UN High Commissioner for Human Rights. Shamdasani said the figures, compiled through its standard vetting processes, were not likely to tell a complete picture, and "we will perhaps never be able to grasp the full scale of what's happening here because of the lack of access" for UN teams to the areas. In a message to The Associated Press, Shamdasani said that of the total deaths, 509 killings were "GHF-related" meaning at or near its distribution sites. "Information keeps coming in," she said. "This is ongoing and it is unacceptable." The GHF has denied any serious injuries or deaths on its sites and says shootings outside their immediate vicinity are under the purview of Israel's military. More deaths reported near aid distribution sites occurred overnight on Friday, according to officials in Nasser Hospital in Khan Younis. At least three Palestinians were killed near aid sites in Rafah, which is close to two operated by GHF. Another 17 were killed waiting for trucks to pass by in eastern Khan Younis in the Tahliya area.
The Advertiser
a day ago
- The Advertiser
'Invariably fatal' rare bat virus claims another victim
A man has died after contracting an extremely rare, rabies-like bat virus, the fourth death since its discovery almost 30 years ago. NSW Health confirmed the man in his 50s died on Thursday after being bitten by a bat several months ago. The northern NSW man was the first recorded case of Australian bat lyssavirus in the state and only the fourth in the nation. Lyssavirus transmits from infected bats to humans when virus in their saliva enters the body through a bite or scratch. Emerging bat viruses expert Alison Peel told AAP the virus, like rabies, travels through the nervous system to the brain. "That happens very slowly so it's quite usual for that to take a number of months between the exposure and the clinical signs developing," the University of Sydney Horizon Fellow said. More than 100 people received medical treatment after potential or suspected exposures each year, Dr Peel said, but it was unknown how many actually contracted the virus. "But certainly, once clinical signs develop ... it's generally, invariably fatal." Australia is home to more than 80 species of bats, and without widespread surveillance of them all, it's safest to assume any bat could be carrying the virus. It was only transmitted through direct contact, so being near bats, or even pooed on by one, was not cause for too much alarm, Dr Peel said. "It's an important consideration to try and avoid direct contact and not touching bats, but we shouldn't panic and take it out on the bats themselves." The virus is also potentially deadly to bats. "It does seem to be circulating within their populations at very, very low levels," Dr Peel said. "But there are quite a high proportion of bats out there that have antibody evidence that suggests that they have been exposed to the virus in the past and they've not become sick. "There is something unique about the way bats are able to handle the infection." It is extremely rare for the virus to transmit to humans because it does not spread through the air. A NSW Health spokesman said anyone bitten or scratched by a bat should seek urgent medical assessment. "Only wildlife handlers who are trained, protected, and vaccinated should interact with bats." People bitten or scratched by a bat require rabies immunoglobulin and rabies vaccine. In 2024, 118 people were treated after being bitten or scratched by a bat around the nation. The virus was first discovered in a black flying fox in Queensland in 1996. A man has died after contracting an extremely rare, rabies-like bat virus, the fourth death since its discovery almost 30 years ago. NSW Health confirmed the man in his 50s died on Thursday after being bitten by a bat several months ago. The northern NSW man was the first recorded case of Australian bat lyssavirus in the state and only the fourth in the nation. Lyssavirus transmits from infected bats to humans when virus in their saliva enters the body through a bite or scratch. Emerging bat viruses expert Alison Peel told AAP the virus, like rabies, travels through the nervous system to the brain. "That happens very slowly so it's quite usual for that to take a number of months between the exposure and the clinical signs developing," the University of Sydney Horizon Fellow said. More than 100 people received medical treatment after potential or suspected exposures each year, Dr Peel said, but it was unknown how many actually contracted the virus. "But certainly, once clinical signs develop ... it's generally, invariably fatal." Australia is home to more than 80 species of bats, and without widespread surveillance of them all, it's safest to assume any bat could be carrying the virus. It was only transmitted through direct contact, so being near bats, or even pooed on by one, was not cause for too much alarm, Dr Peel said. "It's an important consideration to try and avoid direct contact and not touching bats, but we shouldn't panic and take it out on the bats themselves." The virus is also potentially deadly to bats. "It does seem to be circulating within their populations at very, very low levels," Dr Peel said. "But there are quite a high proportion of bats out there that have antibody evidence that suggests that they have been exposed to the virus in the past and they've not become sick. "There is something unique about the way bats are able to handle the infection." It is extremely rare for the virus to transmit to humans because it does not spread through the air. A NSW Health spokesman said anyone bitten or scratched by a bat should seek urgent medical assessment. "Only wildlife handlers who are trained, protected, and vaccinated should interact with bats." People bitten or scratched by a bat require rabies immunoglobulin and rabies vaccine. In 2024, 118 people were treated after being bitten or scratched by a bat around the nation. The virus was first discovered in a black flying fox in Queensland in 1996. A man has died after contracting an extremely rare, rabies-like bat virus, the fourth death since its discovery almost 30 years ago. NSW Health confirmed the man in his 50s died on Thursday after being bitten by a bat several months ago. The northern NSW man was the first recorded case of Australian bat lyssavirus in the state and only the fourth in the nation. Lyssavirus transmits from infected bats to humans when virus in their saliva enters the body through a bite or scratch. Emerging bat viruses expert Alison Peel told AAP the virus, like rabies, travels through the nervous system to the brain. "That happens very slowly so it's quite usual for that to take a number of months between the exposure and the clinical signs developing," the University of Sydney Horizon Fellow said. More than 100 people received medical treatment after potential or suspected exposures each year, Dr Peel said, but it was unknown how many actually contracted the virus. "But certainly, once clinical signs develop ... it's generally, invariably fatal." Australia is home to more than 80 species of bats, and without widespread surveillance of them all, it's safest to assume any bat could be carrying the virus. It was only transmitted through direct contact, so being near bats, or even pooed on by one, was not cause for too much alarm, Dr Peel said. "It's an important consideration to try and avoid direct contact and not touching bats, but we shouldn't panic and take it out on the bats themselves." The virus is also potentially deadly to bats. "It does seem to be circulating within their populations at very, very low levels," Dr Peel said. "But there are quite a high proportion of bats out there that have antibody evidence that suggests that they have been exposed to the virus in the past and they've not become sick. "There is something unique about the way bats are able to handle the infection." It is extremely rare for the virus to transmit to humans because it does not spread through the air. A NSW Health spokesman said anyone bitten or scratched by a bat should seek urgent medical assessment. "Only wildlife handlers who are trained, protected, and vaccinated should interact with bats." People bitten or scratched by a bat require rabies immunoglobulin and rabies vaccine. In 2024, 118 people were treated after being bitten or scratched by a bat around the nation. The virus was first discovered in a black flying fox in Queensland in 1996. A man has died after contracting an extremely rare, rabies-like bat virus, the fourth death since its discovery almost 30 years ago. NSW Health confirmed the man in his 50s died on Thursday after being bitten by a bat several months ago. The northern NSW man was the first recorded case of Australian bat lyssavirus in the state and only the fourth in the nation. Lyssavirus transmits from infected bats to humans when virus in their saliva enters the body through a bite or scratch. Emerging bat viruses expert Alison Peel told AAP the virus, like rabies, travels through the nervous system to the brain. "That happens very slowly so it's quite usual for that to take a number of months between the exposure and the clinical signs developing," the University of Sydney Horizon Fellow said. More than 100 people received medical treatment after potential or suspected exposures each year, Dr Peel said, but it was unknown how many actually contracted the virus. "But certainly, once clinical signs develop ... it's generally, invariably fatal." Australia is home to more than 80 species of bats, and without widespread surveillance of them all, it's safest to assume any bat could be carrying the virus. It was only transmitted through direct contact, so being near bats, or even pooed on by one, was not cause for too much alarm, Dr Peel said. "It's an important consideration to try and avoid direct contact and not touching bats, but we shouldn't panic and take it out on the bats themselves." The virus is also potentially deadly to bats. "It does seem to be circulating within their populations at very, very low levels," Dr Peel said. "But there are quite a high proportion of bats out there that have antibody evidence that suggests that they have been exposed to the virus in the past and they've not become sick. "There is something unique about the way bats are able to handle the infection." It is extremely rare for the virus to transmit to humans because it does not spread through the air. A NSW Health spokesman said anyone bitten or scratched by a bat should seek urgent medical assessment. "Only wildlife handlers who are trained, protected, and vaccinated should interact with bats." People bitten or scratched by a bat require rabies immunoglobulin and rabies vaccine. In 2024, 118 people were treated after being bitten or scratched by a bat around the nation. The virus was first discovered in a black flying fox in Queensland in 1996.
The Age
2 days ago
- The Age
Protoemics diabetes test gets important US health insurance nod
Proteomics International is on the verge of releasing its groundbreaking PromarkerD diabetes-related blood test across the United States, a milestone step ahead the device's international commercialisation. PromarkerD has just been assigned an American Medical Association PLA billing code, required for doctors to order the test and for facilities to bill for its use. From October 1, patients and healthcare providers will be able to submit claims for the test to be reimbursed by their health insurers – an essential step towards a broader market uptake. PromarkerD was designed to meet an area of unmet need by identifying diabetic patients at risk of developing kidney disease four years before any symptoms appear. According to the company's latest clinical study, its patented next-generation PromarkerD test accurately predicted kidney function decline in up to 86 per cent of patients who otherwise showed no symptoms, replicating the results from earlier clinical trials. 'Ensuring kidney health is a priority for our company and obtaining this dedicated PLA code is a crucial milestone in our strategy to improve access to meaningful diagnostic tests.' Proteomics International managing director Dr Richard Lipscombe Catching early signs of diabetic kidney disease means patients can receive preventive care well before they develop costly and life-threatening end-stage kidney disease, avoiding the need for dialysis or a kidney transplant. The simple finger-prick blood test could potentially throw a lifeline to more than 32 million Americans living with type 2 diabetes, given more than half of all adults with diabetes in the US will develop kidney complications. These cases contribute to a colossal US$130 billion in annual healthcare costs - more than a quarter of the nation's Medicare budget. Proteomics International managing director Dr Richard Lipscombe said: 'Ensuring kidney health is a priority for our company and obtaining this dedicated PLA code is a crucial milestone in our strategy to improve access to meaningful diagnostic tests. Expanding access to PromarkerD will help to improve kidney health for patients everywhere.' The PLA code is widely used across America's complex health insurance system to report the use of medical procedures and services. It also allows insurers to monitor their use.
