Doctors and clinic operators are accused of ‘systematic fraud’ after it was revealed that one doctor activated $1.5m worth of Covid tests in a single day.
In that case, the doctor requested 21,000 tests for a single day, which violated the regulations that require doctors to clinically evaluate each case individually.
At the standard bulk billing rate of $72.25 for the Covid test, the doctor would have had to pay Medicare $1.5 million.
Professor Stephen Duckett, a health economist and former secretary of the Department of Health and Aged Care, said it was a clear scam but had apparently been approved.
“This doctor could not have seen that number of patients and made an informed decision, whether it was routine testing or symptomatic testing, it’s just not possible for that to have happened,” he said.
The Department of Health and Aged Care has received 47 notices alerting it to potential Covid testing fraud in South Australia, according to Freedom of Information documents obtained by The alphabeth after a three-year battle for access.
Companies that were compensated for operating State- and federally funded pop-up and drive-thru testing clinics continued to claim the full cost from Medicare and double-bill, the documents show.
Tests were also requested for people who did not have a valid referral from a doctor or nurse.
Freedom of Information Act documents reveal concerns about corruption in Medicare payments for Covid testing during pandemic
Professor Duckett said it was clear there was “large-scale, systematic corruption” that had often affected Medicare rather than state government.
Professor Duckett said the testing centres should have known if they were set up by the state government and sent the bills there rather than to Medicare.
“I think it’s deliberate,” he said.
Professor Duckett said documented claims of flu and RSV testing at drive-throughs should have been a red flag that potentially “opportunistic” claims had been made.
The pop-up, drive-thru clinics were designated solely for Covid testing and anything else was “not consistent” with the rules, Professor Duckett said.
In response to concerns about the tests, the Department of Health wrote to nine pathologists and four pathology firms in October and November 2020 “reminding them… that the tests needed to be clinically relevant to be claimed through Medicare”.
In September 2021, six more letters were sent to pathology companies telling them that asymptomatic or surveillance tests must be claimed through the state government, not through the federal government’s Medicare program.
A doctor claimed to have performed 21,000 tests in a single day, which could lead to a $15 million Medicare claim
In December 2021, seven pathology companies received such warnings, but the names of the recipients have been withheld.
Professor Duckett said it appeared the letters were being largely ignored.
“They are very powerful operators, but it seems that they are not held accountable, which is what should happen,” he said.
Liesel Wett, chief executive of Australia’s peak pathology body, denied there was corruption and said assessors were subject to routine compliance checks.
“To our knowledge, there have never been any significant findings of Medicare non-compliance by Australian Pathology members during the period,” he said in a statement to the ABC.
He also said there were multiple checks and balances in the system and that during the pandemic a referral was not required to get tested.
‘The overwhelming public health message from all levels of government was to get tested if you felt you had symptoms or felt you had been exposed, particularly considering you were required to isolate until you had the results of a test.
“It would have been absurd to refer patients to their family doctor.”
By January 2022, there had been approximately 27.8 million bulk-billed Covid tests performed at a cost of about $2.3 billion to Medicare.
Health economics professor Stephen Duckett said there were many signs of “systemic corruption” of Medicare by Covid examiners.
The Department of Health and Aged Care spokesman said it had “robust” compliance programmes in place.
Although the department said it could not detail all of its “investigations and treatments”, writing to the pathology companies was the only step it took.
“The department does not assume non-compliance based on data alone. In general, additional information needs to be evaluated with the health care professional performing the test, the testing provider, or state government,” it said.
“Compliance activities undertaken at that time resulted in a significant shift toward compliant billing. Compliance in this area is being studied.”
By January 2022, there had been approximately 27.8 million bulk-billed Covid tests performed, at a cost to Medicare of about $2.3 billion.
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