Jill Hall (Shortland, Australian Labor Party) Share this | Hansard source

The legislation that we have before the House today will give effect to two components of the increased MBS compliance audit initiative, which was announced by the government in the 2008-09 budget. In fact, this bill is largely identical to a bill that was introduced in the 42nd Parliament, and I believe I spoke on that bill when it was before the parliament then.

The Health Insurance Amendment (Compliance) Bill 2010 enables Medicare Australia to give a notice requiring the production of documents to a practitioner, or another person who controls the documents, to substantiate a Medicare benefit paid in respect of their professional services. Practitioners may be liable for financial penalties where the amount paid in respect of the service cannot be substantiated—and that largely depends on the amount that cannot be substantiated.

Though this is not the type of legislation that is going to be highlighted on the nightly news, it is important legislation because it is about the integrity of Medicare, about enhancing the current audit requirements and about delivering on the government’s commitment to financial responsibility and good economic management. It is also about transparency and accountability and the long-term future viability of our Medicare system—a system that I believe is second to none in the world. It is about ensuring that here in Australia we continue to have one of the best health systems available to any person.

The legislation has been subject to widespread consultation. It has taken into account the thoughts and opinions of stakeholders and consumers. Out of that consultation and the fine work that has been done by the department we have come up with legislation that is very workable and will make an enormous contribution to the long-term viability of Medicare.

Members may know that in 2009-10 the Medicare benefits scheme was $15 billion and has grown by more than $1 billion per annum over the last three years. Significant government finances are being spent on MBS payments; therefore it is very important that there be a level of accountability. When the current compliance audits are conducted, on average 20 per cent of practitioners contacted by Medicare Australia do not respond or refuse to cooperate—that is, 20 per cent are not accountable. The MBS benefit is paid to them through Medicare, so I see it as very important that they, like all other players within the system, are in some way accountable. Without that accountability there is no way to confirm that the medical benefits that have been paid are correct. This legislation will address that deficiency.

Also, one of the difficulties with this bill was balancing the public interest to ensure the integrity of public expenditure on the MBS and to protect medical services with privacy concerns. Whenever we are looking at doctors’ records, we have to be very mindful of the fact that there could be some privacy issues involved. The Senate Community Affairs Legislation Committee inquiry into Medicare compliance audits recommended that patients’ clinical records only be accessed where necessary. The bill provides that documents containing clinical details do not have to be produced unless they are necessary to substantiate the Medicare benefit. Instead of the doctor having to provide these documents to an administrative auditor in the system, they can choose to provide them to a medical practitioner employed by Medicare. I think that that should allay fears to some degree because it will be viewed by someone who has some understanding of the clinical issues associated with the service provided.

Before a notice to produce a document can be issued, the CEO must fulfil several conditions: the CEO must have a reasonable concern that Medicare benefits paid for a service may exceed the amount that they should be paid; the CEO must take advice from a medical practitioner employed by Medicare on the types of documents that a practitioner would need to produce so that they can substantiate the Medicare claim; the CEO must take reasonable steps to consult with a relevant professional body—if there is concern with a doctor employed by Medicare then they consult with professional bodies; and the CEO must give the person a reasonable opportunity to respond to a written request to voluntarily provide documents. This bill does not introduce any bookkeeping requirements; it is about compliance and checking, and ensuring the integrity of Medicare and that the right payments are made.

Medicare Australia has been working with the AMA and other stakeholders in developing the guidelines. The degree of consultation in relation to this piece of legislation has been quite extraordinary. It is because of that consultation that stakeholders are quite happy with the legislation we are debating today. The fact that the Senate committee also considered this particular piece of legislation should give all a degree of certainty that this is the appropriate legislation to cover this area.

At present, if an amount paid for a service cannot be substantiated, the practitioner is required to repay that amount. This will continue to occur. However, this bill introduces a financial penalty for certain practitioners who cannot substantiate the amount paid for the service. The financial penalty will only apply to debts over $2,500—and I alluded to the fact that there was a financial limit earlier.

The bill provides for a regulation-making power to enable this threshold to be increased and for adjustments to occur. A penalty base of 20 per cent will be paid on all debts over $2,500. If a practitioner tells Medicare Australia that an incorrect amount has been paid for a service prior to being contacted by the CEO the penalty will be reduced by 100 per cent; before the notice to produce the documents is issued, by 50 per cent; and after the notice to produce documents, by 25 per cent. The medical practitioner has the opportunity to correct the record and provide the correct information early in the piece.

Mistakes are made—for example, with bookkeeping. The majority of medical practitioners always do the right thing. Some medical practitioners may have a little problem with their bookkeeping—and it is accidental. A very miniscule number do the wrong thing. This legislation will ensure that that does not continue to happen. I urge members to support this legislation. It is about ensuring the ongoing viability of Medicare. It is about putting in place not only a system that provides the best services—in what is, I think, the best health system in the world—but also compliance requirements that will ensure the ongoing viability of the system.

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