Doctors cannot turn a blind eye to the fraud that occurs within their profession, says top doctor Dr. Nick Coatsworth.
A bombshell investigation by the Sydney Morning Herald and the ABC on Monday claimed an estimated $8 billion a year is being siphoned from Medicare by doctors billing for services they did not provide or over-serving patients.
Extreme cases involved a general practitioner who billed dead people in a nursing home, a dentist who exposed children to radiation for unnecessary procedures, and doctors who misdiagnosed conditions such as diabetes to claim a higher Medicare rebate.
Dr. Nick Coatsworth has responded to claims of massive Medicare fraud by saying it’s a simple matter for doctors to cheat the system
Dr. However, Coatsworth said fraud would occur any time a doctor bills the taxpayer for a complex consultation when it is actually simple.
“Very interesting responses to the abuse of Medicare funds article today, especially strong responses to the use of the word ‘fraud,'” tweeted Dr. Coatsworth.
In a series of tweets, Dr. Coatsworth, although there were many hard working and honest doctors that did not mean the problem did not exist
‘Unfortunately, here’s how simple it is. If we bill for a complex consultation when it was a simple one [one]it’s fraud.’
Peak doctors’ body, the Australian Medical Association (AMA) reacted furiously on Monday to allegations of widespread Medicare cheating, which it called ‘an unjustified slur on the medical profession’.
“The AMA works closely with the Department of Health on compliance and we have never seen any concerns or figures that would support the figures reported today,” said AMA President Professor Steve Robson.
‘Doctors will be sickened by today’s reporting, which is an undeserved attack on the entire profession based largely on anecdotes and individual cases.’
Dr. Coatsworth, who is a former deputy physician, agreed that “there will be hard-working clinicians who find the article offensive,” but that did not nullify the allegations.
Medicare loses $8 billion a year to fraud and misdiagnosis, according to a bombshell new report
“However, we have to admit that it is very plausible that over-service is occurring, excessive billing is occurring and the police are only getting the tip of the iceberg,” he said.
“It is clear that only a small minority of doctors would bill deceased patients. I would love to see us engage with the problem instead of reacting as if it doesn’t exist.’
On ABC’s 7:30 current affairs program, Dr. Austin Sterne, a founding partner of south-east Queensland ‘Superclinic’ Tweed for Health All detailed shocking allegations of alleged medical malpractice at his former workplace.
Dr. Austin Sterne, who co-founded a so-called super clinic in south-east Queensland, claimed fraud was rife at his former workplace and alleged a GP even misdiagnosed people with diabetes to claim more Medicare money
“There was falsification of patient records,” he said.
“Medicare was being billed for services that had not been provided and there was also over-service going on.”
‘A particular practitioner in the clinic diagnosed patients with diabetes when they had not developed diabetes.
“They may have had pre-diabetes, but it’s not diabetes, because if a patient is diagnosed with diabetes, there’s an additional Medicare item number and a fee that has to be paid for every patient you have who has type 2 diabetes .”
AMA president Professor Steve Robson has called the report on the Medicare rorting an ‘undeserved attack on the whole profession based very much 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 when no patients were seen at all.
Dr. Sterne said he was forced to resign from the clinic to try to stop the alleged fraudulent practice.
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 gobbled up by medical malpractice
“I think most Australians think doctors are honest people,” Faux said.
“But the reality is anywhere you have a huge pot of money that’s super easy to access, you’re going to have bad actors building business models just taking the money illegally.”
Dr. Faux estimates that $8 billion a year is lost to physician overpayments, which is nearly a third of the program’s total budget.
That figure was backed up by Dr. Tony Webber, who ran the Medicare regulator Professional Services Review.
He said that when doctors were caught overcharging, they would sometimes make the excuse: ‘Well, everyone else is doing it, why shouldn’t I?’.