Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to this | Hansard source

I rise today to speak on the Health Insurance Amendment (Compliance) Bill 2010 which, for a variety of reasons, has been subject to much debate in the previous parliament. The bill implements the increased Medicare compliance audits measure from the 2008-09 budget. This measure proposed to increase Medicare compliance audits from 500 to 2,500 per year and increase powers to secure documents from doctors to substantiate Medicare claims.

The Department of Health and Ageing has highlighted the considerable growth of the MBS over recent times. From 2004-05 to 2008-09 the number of MBS items grew by 23 per cent, the number of providers grew by 15 per cent, MBS transactions grew by 17 per cent and there was a 43 per cent increase in the value of MBS claims. With $15 billion of taxpayers’ money spent on Medicare each year and clearly growing rapidly, it is appropriate that there are robust mechanisms to investigate and discourage incorrect or false claims. Separate to investigating clinical issues, as is the case with the Professional Services Review, the compliance process focuses on inappropriate billing and claiming.

The government claims that 20 per cent of practitioners do not respond in relation to compliance audits or refuse to cooperate with requests to substantiate benefits paid. And they further argue that Medicare does not currently have the power to make medical and health practitioners comply with requests. Based on this information, there is a case to make legislative changes. However, the documents required to substantiate claims may contain patient clinical information, which is why we rightly need to approach this matter with caution.

The bill was first released as an exposure draft in April 2009 and referred to the Senate Community Affairs Committee for inquiry. The exposure draft generated a strong response. The main concerns were with respect to third parties viewing patient clinical information and the impact this may have on the practitioner-patient relationship. The majority report also raised questions about Medicare staff qualifications and capacity to interpret and make judgments regarding clinical records.

An important point, made in evidence to the committee, is that the MBS is indeed complex and a significant proportion of incorrect claims appear not to be deliberate. There are large demands on health practitioners and their offices and there will inevitably be some administrative errors from time to time. It is important, though, to stress in this debate that incorrect claims are not necessarily the result of fraudulent activity.

There is a continuing role for government to simplify the MBS and to provide sufficient education and guidance regarding its interpretation. These common-sense measures do improve compliance, without patient privacy issues resulting from using patient records as part of an audit process.

In balancing the needs of patient privacy and the proper use of taxpayers’ funds, the coalition proposed a number of amendments to enhance safeguards in this legislation. The government has largely included these amendments in the bill presented to this parliament. As a result of the coalition’s amendments, Medicare must consult with relevant professional bodies about the types of documents that contain information relevant to ascertaining whether payments should indeed have been made; requests for information and documents must now be made in writing; notice must include the reason for the CEO’s concern about the payment and must explain the factual issue that the person is required to substantiate; notice to produce documents will not include requests for information about whether a particular service was clinically relevant; and a person may provide Medicare with additional information to substantiate an amount.

Other amendments to this bill were approved by the Senate at the time but rejected by the Minister for Health and Ageing. These amendments to the Health Insurance Act would have allowed the parliament to disallow items on the General Medical Services Table and for the previous items and associated rebates to be revived. The amendments were instigated by the minister’s arbitrary halving of rebates for cataract surgery.

Unfortunately, at the time, and as is so often the case, the minister refused to negotiate with the patient and doctor groups or allow for greater parliamentary scrutiny of changes to the General Medical Services Table and blocked the amendments in this chamber.

The minister’s refusal to support the Senate’s amendments prevented the original bill passing the previous parliament. Eventually the minister was forced into a backflip, was forced to negotiate with patient groups and ultimately doctors and arrived at a compromise position. This of course should have been the process from the outset, but instead many patients were left substantially out of pocket because of the minister’s unreasonable delay to negotiations.

The legislation before us provides that the Medicare CEO must have a reasonable concern that a benefit paid for a service exceeds the amount that should have been paid. It is important to note that Medicare cannot conduct random compliance audits. The audits are only to ascertain that a service claimed was actually undertaken and under section 129AAD, subsection (9), clinical relevance of the service can not be taken into account.

The CEO must also take advice from a medical practitioner employed by Medicare on what types of documents may be requested for the purposes of this bill. Section 129AAD, subsection (6), stipulates that any documents that contain clinical information do not have to be produced to anyone other than an employee of Medicare Australia who is a medical practitioner.

Under this legislation Medicare can only compel the production of relevant documents if the person has been given a reasonable opportunity to respond to a written request to produce relevant documents. The bill does not stipulate a record-keeping requirement. However, under section 129 AAD, the notice to produce documents must specify details of each professional service for which documentary evidence is required; the reasons for the concern that an amount paid may exceed the amount that should have been paid; the information relevant to ascertaining whether amounts paid should have been paid; how the document, extract or copy is to be produced; and, finally, the period within which and place at which the document, extract or copy is to be produced.

It is appropriate that there is clarity for health professionals as to what needs to be provided and the reasons for it. The explanatory memorandum does specify that Medicare is working with the AMA and other stakeholders to develop guidelines about the types of information that may be required to substantiate claims. It is stated that the guidelines will emphasise that patient records and clinical information should only be provided where absolutely necessary. The coalition does emphasise the importance of this point and the need to carefully monitor and scrutinise the use of clinical information once this measure is implemented. The confidentiality of the doctor-patient relationship should remain paramount.

Another change this bill makes is to introduce penalties for debts that exceed $2,500. This threshold is justified in the explanatory memorandum on the basis that it reflects the point at which mistaken claims may become routine, reflective of poor administration or decision making. Section 129AEA, subsection (1)(d), does allow for a higher threshold to be specified by regulation. As Medicare rebates grow, it is important that the threshold is reviewed so that it does, as accurately as possible, reflect a point where incorrect claims are more than incidental or the result of isolated administrative mistakes. The penalty is to be 20 per cent of the debt.

The financial penalties in this bill are intended to encourage early and voluntary identification and repayment of incorrect claims. Where a person voluntarily contacts Medicare to inform that an incorrect payment or claim has been made, the penalty is reduced in full. If the person voluntarily informs Medicare after being contacted, but before notice is given to produce documents, the penalty is reduced by 50 per cent. Finally, if the person voluntarily informs Medicare after notice is given, but before the end of the period specified in the notice, the base penalty is reduced by 25 per cent.

In addition, to improve compliance and reduce recidivism, there are circumstances where the base penalty can be increased. If a practitioner does not respond to a notice, the full amount of the services identified becomes repayable and the penalty is increased by 25 per cent. Similarly, if a practitioner has been unable to substantiate an amount paid for other services in the previous 24 months and the total amount repaid exceeded $30,000, the penalty for the current amount is increased by 50 per cent.

Whilst the government may be focused on the compliance of health practitioners, when it comes to Medicare claims they are, as we now know, less forthcoming with transparency in their own actions and proposals. In fact, the government has directly undermined not only medical practitioners in relation to Medicare but also the fundamental principles on which Medicare has been built. Under the government’s first version of health reform last year, GP surgeries would have lost $58 million in Medicare practice incentive payments for after-hours patient care. The then President of the Royal Australian College of General Practitioners, Dr Chris Mitchell, was reported as saying on 15 July 2010 that the removal of Medicare incentive payment will have ‘enormous implications for the role of the GP’ and ‘has the potential to have an impact on the viability of general practice to deliver the services outside normal opening hours’. In fact, Dr Mitchell went further and said it would:

… jeopardise the availability of after-hours services in some areas and potentially increase the burden on ambulance callouts and emergency department presentations.

Furthermore, at a press conference on 22 February 2011, the Prime Minister stated that Medicare Locals will be ‘fund-holding organisations’. The government has refused at every turn to specify the services for which Medicare Locals will have fund-holding responsibility. This is a significant departure from the existing model of fee-for-service and, indeed, patient choice and creates enormous uncertainty for doctors and patients.

The Prime Minister also implied that Medicare Locals will provide coordinated care and address the issue of patients having to provide records to different health professionals. It is unclear from this comment whether Medicare Locals will have access to patient records, have copies of patient records or be able to compel doctors to provide patient records. Given that the so-called legal entities will be staffed by teams of bureaucrats, it does again give rise to concerns about the use of clinical information without consent by people other than medical practitioners.

The intent of this bill is to ensure that taxpayers’ funds are used appropriately. This is from a minister that allocated $29½ million to advertising a health reform proposal that was never delivered. This is from a minister that has spent hundreds of millions of dollars on so-called superclinics that are still not operational and in many cases will erode the viability of existing services. This is from a government that has wasted billions of dollars on putting pink batts into people’s rooves and taking them out again. This is from a government that will spend over $20 billion in interest payments on its debt over the next four years alone. Incredibly, this government’s unprecedented waste and mismanagement make the $70.3 million saving from this measure look like a simple rounding error.

Whilst the government today is trying to apply scrutiny to doctors and those on the frontline, it has to be said that it is the Gillard government and Minister Roxon herself who are more deserving of intense scrutiny for their array of policy failures and unimaginable waste.

A number of amendments have been adopted addressing key concerns with the original version of this bill. The coalition does not oppose the bill before us today, but we will continue to scrutinise its implementation and the government’s actions in relation to Medicare which undermine patient privacy and choice and, as importantly, give rise to waste.

Tanya Plibersek (Sydney, Australian Labor Party, Minister for Human Services) Share this | Link to this | Hansard source

I rise to support the Health Insurance Amendment (Compliance) Bill 2010. This bill represents a major step forward for the compliance and auditing functions of Medicare Australia. It delivers essential new powers for the enforcement of Medicare’s audit processes, while protecting patient privacy and the integrity of clinical information.

Commonwealth spending under the Medicare program is currently around $15 billion a year—a $4 billion increase since Labor’s election in 2007. Under the previous government, Medicare was left to stagnate, health funding was slashed and bulk billing rates declined. Australia’s universal healthcare system became weaker and less fair. Since 2007, this government has restored fairness and growth to Medicare. Rebates have increased, bulk billing is up, and more Australians are receiving assistance with their healthcare needs than ever before. Medicare has also been extended to a range of new allied healthcare providers and to additional dentistry services. Last year, more than 101,000 health professionals provided over 308 million services, claimed against nearly 6,000 Medicare item numbers.

Coupled with this expansion of services is the need for a strong compliance function that protects the Commonwealth’s investment. Medicare Australia already operates a rigorous system of auditing and investigation, acting on tip-offs and its own investigations, to identify incorrect claims. Audits check that the practitioner and the patient were eligible for Medicare benefits and that the service was actually provided. These are strict questions of fact. Medicare audits do not examine clinical decision making or the appropriateness of services provided but only whether they were legitimately charged for and actually delivered.

In 2008 this government provided funding for Medicare Australia to audit around four per cent of providers—up from one per cent under the coalition. In 2009-10 Medicare completed 3,600 audits and identified more than $10 million in incorrect claims. Some 159 formal investigations were completed and involved 21 medical practitioners, seven pharmacists and 131 members of the public. In one case, a medical practitioner was ordered to repay $180,000 after bulk-billing patients for procedures not discussed during patient visits.

Medicare’s audit team is regarded in the healthcare industry as highly professional and fair. A 2010 survey of 200 Australian health professionals found that 93 per cent agreed or strongly agreed that they were treated in a professional manner during the audit, and three-quarters found the information provided to them to be helpful in correctly interpreting the MBS.

However, under laws inherited from the previous government, health professionals are not required to assist with Medicare audits and can simply refuse to produce documents that substantiate their claims. Up to 20 per cent of health professionals refuse to co-operate with Medicare auditors. This refusal can jeopardise audit outcomes. Unless Medicare Australia can identify and interview the patients of these practitioners directly, it can be unable to complete the audit or determine whether Commonwealth funds have been correctly claimed.

The bill before the House addresses this deficiency in compliance procedures. Under the bill, Medicare Australia may issue notices to practitioners requiring the production of documents to substantiate Medicare claims. Failure to respond may result in a debt to the Commonwealth of the audited amount plus a penalty of up to 20 per cent. Where a practitioner was also unable to substantiate amounts paid for other services in the previous two years, and the total they repaid was more than $30,000, the penalty for the current amount being recovered is increased by 50 per cent. To encourage voluntary compliance, penalties may be reduced if an incorrect payment is identified early by the practitioner and directly refunded. The bill also creates an internal review process so that health professionals can have audit outcomes re-examined in case of dispute.

The government has worked closely with medical stakeholders and professional bodies in developing this bill to ensure that its provisions are fair to practitioners. Under the bill, Medicare must establish a ‘reasonable concern’ in relation to the services being audited and communicate this to the health professional. Medicare must also take the advice of an internal medical adviser about the types of documents it may seek for auditing purposes and regularly consult with a relevant professional body on the issue. Notices to produce documents may only relate to services that were rendered in the two-year period immediately prior to the notice being issued. Where clinical documents are required to be produced, a health practitioner may elect to forward these to a Medicare medical adviser, who will themselves be a qualified health professional.

As my colleague the Minister for Health and Ageing has already outlined, the bill does not introduce any new record-keeping requirements for health professionals or their practice staff. It will be up to the person who receives the audit notice to decide what documents they have available to substantiate the services for which they have claimed.

The bill also has strong regard for patient privacy and was developed in consultation with the Office of the Privacy Commissioner and with healthcare consumer organisations. A comprehensive privacy impact assessment was conducted in 2008, and this assessment was examined in further detail during the 2009 inquiry by the Senate Community Affairs Legislation Committee.

Amendments have been made to the bill to strengthen privacy controls. Risks to patient privacy have been mitigated through the requirement that clinical information need only be provided when it is strictly necessary to substantiate a claim and by enabling health professionals to elect to provide this information directly to Medicare medical advisers. The actions of Medicare Australia in conducting its audits are also subject to the secrecy provisions set out in the Health Insurance Act as well as the information privacy principles set out in the Privacy Act 1988.

A strong compliance regime is an essential part of Labor’s approach to Medicare and to government spending generally. This bill delivers that stronger compliance but balances it with practitioner safeguards and privacy protections for patients. It is the product of exhaustive consultation with healthcare stakeholders, consumers and privacy advocates and it has broad support across the health and medical community. Every dollar saved by the prevention of incorrect claims is a dollar that can be reinvested in government services and service delivery. The vast majority of health professionals are honest and accurate in their Medicare claims, as are the vast majority of patients. This bill will ensure that the minority of incorrect claims are identified and swiftly repaid.

I commend the bill to the House.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to 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.

Andrew Leigh (Fraser, Australian Labor Party) Share this | Link to this | Hansard source

Medicare is a central component of Australia’s universal healthcare system. It is a system that provides affordable treatment for Australians by the dedicated health professionals in our public health system. Introduced in 1975 by the Whitlam government, Medibank—as it was then—allowed for the subsidisation of medical treatment in public hospitals that has made health care more accessible and affordable and has added to the quality of the lives of Australians over the last 35 years. I want to place on record the role played in creating Medibank by Dick Klugman, member for Prospect from 1969 to 1990, who passed away just recently, on 21 February. In 1984, Medibank was renamed Medicare by the Hawke government, who returned it to the original model to reflect the great traditions of equity, fairness and dignity for all Australians—which are characterised by us in the Labor Party. The Health Insurance Amendment (Compliance) Bill 2010 adds to the history of responsible Labor governments by balancing the public interests of confidentiality and privacy with ensuring that public funds are spent appropriately and responsibly.

As part of the governments responsible economic management policy agenda, the Health Insurance Amendment (Compliance) Bill 2010 proposes to amend the Health Insurance Act 1973 to implement the increased Medicare compliance audits initiative announced in the 2008-09 budget. With expenditure on the Medicare benefits scheme over $15 billion in 2009-10, it has grown by more than $1 billion per annum over the last three years. This bill will put in place a system of compliance audits—checks that make sure that the services that are delivered meet Medicare item requirements. We are doing this in order to ensure that taxpayers’ money is spent appropriately, as taxpayers, I am sure, would wish to be the case.

Presently, medical practitioners are not required to produce documentation during a compliance audit conducted by Medicare Australia, and Medicare Australia does not have the authority to require compliance with the request. As a result, around 20 per cent of practitioners either do not respond or else refuse to cooperate with an audit request. This bill addresses that problem.

The bill enables the Chief Executive Officer of Medicare Australia to give notice of the production of documents to a practitioner to substantiate a Medicare benefit paid for a service. To address concerns of due process raised by key stakeholders in the process, the government has put in place four safeguards. Before a notice to produce documents can be issued, the CEO must first have a reasonable concern that the Medicare benefit paid for a service may exceed the amount that should have been paid. This means that Medicare Australia cannot conduct random compliance audits under the provisions of this bill. Secondly, the CEO must take advice from a medical practitioner employed by Medicare Australia on the kinds of documents a practitioner may need to provide in order to substantiate that kind of benefit. Thirdly, the CEO must take reasonable steps to consult with a relevant professional body about the types of documents required to substantiate a benefit before commencing a compliance audit; and, fourthly, the practitioner must be given a reasonable opportunity to respond to a written request to voluntarily provide relevant documents.

As a result, this bill does not add to the workload and record-keeping requirements of already busy practitioners. Provisions for the protection of sensitive information ensure that only information relevant to the purpose of substantiating benefits is produced. No clinical or private details will be required unless they pertain to the substantiation of the benefit payment.

Medicare Australia is also working with the Australian Medical Association and other stakeholders to develop guidelines for practitioners on the kinds of information that may be used to substantiate particular services or groups of services. In accordance with this bill, practitioners must be given 28 days in which to seek an internal review of an audit decision before a debt notice is issued. During this time a practitioner may provide additional material to the CEO to substantiate a Medicare benefit.

The Health Insurance Amendment (Compliance) Bill 2010 will provide savings of around $148 million over four years, and it is expected that the provisions contained in the bill will generate further savings of at least $132 million during this time. Protecting the integrity of Medicare and enhancing Medicare Australia’s current audit program is a crucial element in ensuring that the Australian people know their public funds are spent appropriately and responsibly in the provision of the health services they rely on. The Gillard government is committed to responsible economic management and delivering the world-class services that Australians are entitled to expect—all this in the great traditions of the Labor Party, the originators of Medicare. I commend this bill to the House.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

in reply—It gives me great pleasure to speak on the Health Insurance Amendment (Compliance) Bill 2010 and to thank the members who have made contributions to this debate. Sometimes these sorts of bills can seem very technical but everyone in this House—and certainly on our side of the House—does not underestimate the importance of Medicare and making sure that it is used in a way that is transparent, accountable and to the benefit of patients. This bill is about making sure that the transparency and accountability at the core of our broader health reforms are also able to be applied within the Medicare system itself.

We on the government side make no apologies for wanting to be very transparent about the way that we spend taxpayers’ money and how we account for all healthcare services, whether they are delivered in public hospitals, in the community or through general practice, pathology, diagnostic imaging and the many other ways that we pay for health services that people need.

This bill, as I have said, ensures that transparency and accountability from healthcare practitioners is achieved if they want to provide Medicare funded services. The bill is a reintroduction of a largely identical bill that was introduced into the 42nd Parliament, but this version incorporated parliamentary amendments that had been agreed to or moved by the government during the parliamentary debate in the previous parliament.

The reason that it is necessary for this bill to be passed—and I am pleased that the opposition have indicated they now support this bill—is that 20 per cent of practitioners contacted by Medicare do not respond to or refuse to cooperate with a request to substantiate a Medicare benefit that is paid for a service. When this occurs, Medicare currently does not have the authority to require a practitioner to comply with this request. This means there is no way to confirm that the Medicare benefit was correct and that public money is being spent appropriately.

I want to emphasise, as I know many colleagues from the AMA and other professional organisations did want us to make clear, that the vast majority of practitioners do comply with those requests, and the bill will not have any effect when people comply with those requests and make clear that the claims they are putting forward can be properly substantiated.

This bill, not surprisingly, has had significant debate, a lot of stakeholder consultation, a full inquiry by the Senate Community Affairs Legislation Committee and now a range of amendments that I think address all of those significant issues that have been raised. The amendments acknowledge the need for Medicare to take advice from medical professionals from within the organisation and to use the profession to assist doctors in responding to an audit. Of course, when we use that 20 per cent figure, many of those claims can be justified and the practitioners are appropriately claiming and using taxpayer funds. For the small number that are not, it is important that we give Medicare the authority that it needs.

I want to also emphasise that the bill does not introduce any record-keeping requirements that do not otherwise already exist. It will be up to the person who receives the notice to decide what documents they have available to substantiate the service. This bill is not retrospective and will only apply to Medicare services provided after the commencement of the bill.

So there is no reason why the parliament should not consider this legislation. We believe it marks another important opportunity for greater transparency in the health system and to make sure that taxpayers’ money is being spent appropriately on the healthcare services they expect. I would like to thank not just all the members who contributed to this debate but all the people who participated in the earlier Senate committee inquiry. I again thank the opposition for now supporting this important legislative change. I commend the bill to the House.

Question agreed to.

Bill read a second time.

Ordered that the bill be reported to the House without amendment.