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

I move:

That this bill be now read a second time.

The Medicare Chronic Disease Dental Scheme has been the most successful dental program in Australia's history. Over 17 million services have been provided to approximately one million patients since 2007. So one must ask the question: why would the government seek to discredit this scheme? The answer is simply that Tony Abbott, as health minster, introduced the scheme.

Nearly 12,000 dental practitioners have provided services under the scheme. Their patients have chronic health conditions and many have not seen a dentist in years. The dental problems, often complex, risk exacerbating an underlying chronic health condition. The services provided by these dentists have ensured timely access to treatment, which has greatly improved the health and quality of life of their patients.

Dentists treated patients after receiving a referral from a general practitioner and mostly did so at no cost to the patient. Whilst many dentists had never had any involvement with Medicare previously, they appreciated the enormous benefit of the scheme for their patients. Despite claims of expenditure blow-outs, the average claim per patient is $1,716, well below the allowable $4,250.

Unfortunately, the goodwill of dental practitioners and the success of the scheme for patients are being seriously undermined by the actions of the government. This bill will require the minister to remedy a serious situation facing dental practitioners who have participated in the Chronic Disease Dental Scheme. The practitioners concerned are being ordered to fully reimburse Medicare as a result of minor administrative oversights.

The government establishment an audit taskforce in June 2010 after its attempts to close the scheme were rejected by the Senate. There is no argument against a transparent and appropriate audit process to detect cases of fraud, misuse of taxpayers' funds or the provision of inappropriate services. However, the situation this bill seeks to redress is where dentists have been found to be non-compliant and action has been pursued against them for minor, technical mistakes with paperwork. In most cases, the dentists being caught by the audit process have provided appropriate services to patients in need but merely did not comply fully with a technical requirement to provide general practitioners with treatment plans, and to provide patients with treatment plans and quotations for services prior to commencing treatment. This is not fraud.

It is important to remember that this was the first interaction most dentists had with Medicare. In many cases, dentists attempted to rectify the situation as soon as they became aware of the requirement. Some dentists, once aware, immediately sent treatment plans to GPs before an audit had even commenced.

In recognition of this, investigating compliance officers have in some cases recommended that an 'educational letter' be sent to the dentist and no further action be required. That would seem to be the sensible course of action. Incredibly, even when that option has been recommended by the compliance officers, dentists still received letters of demand for repayment of Medicare benefits. Dentists have had their reputations ruined, some are facing bankruptcy, and professional trust in government funded dental schemes is being destroyed as a result of this process.

Last year Minister Plibersek, the then Minister for Human Services, was reported in the media as having told the Australian Dental Association that 'there is no scope for the Department of Human Services to not follow through on recovery action'. The argument being relied on by the government is that section 10, subsection 2, of the Health Insurance (Dental Services) Determination 2007 provides that the government has no choice but to pursue full recovery action in even the most minor, technical non-compliance cases. There are a number of problems with this argument.

In evidence to the Finance and Public Administration Legislation Committee inquiry earlier this month, an Assistant Secretary of the Department of Human Services said:

The minister has asked us to advise the committee that, notwithstanding the government's intention to close the scheme completely, he accepts that some but not all of the concerns that have been raised do require further consideration and that is a matter that is now underway within normal departmental processes …

While it is somewhat a relief that the government now at least acknowledges that there is problem, it is perplexing that the ministers responsible still refuse to do anything about it.

There have been 94 audits completed and 65 practitioners have been found to be non-compliant according to evidence provided by the Department of Human Services—that is, 70 per cent of dentists audited are in breach of the scheme. At additional estimates hearings in February, evidence was provided showing that of the dentists found to be non-compliant, over 80 per cent had provided all the services that were claimed. So on the government's own figures, the vast majority—over 80 per cent—of dentists found to be non-compliant, and potentially labelled as rorters, have provided the services claimed. That 80 per cent of dentists are being pursued, some to the point of bankruptcy and professional ruin, because forms were not sent on the correct date.

Despite the government claiming that there is no room for discretion in applying the law, there have been a limited number of instances where there has been education action and no recovery has occurred. However, this has not been consistently applied. Submissions to the inquiry and also to my office provide many examples where this should have occurred but has not. Nevertheless, it does indicate that there is capacity to apply sensible discretion, which, for whatever reason, has not been pursued.

Minister Plibersek even advised the ADA on 29 July 2011 that: 'Where the dental practitioner is found to be generally compliant with the requirements of the CDDS, this will generally be the end of the audit.' Unfortunately, the government does not appear to have applied this advice with any degree of consistency or predictability.

Even if the minister was correct originally, and there is no discretion in applying the relevant sections of the determination in these instances, the most obvious solution is for the minister to amend the determination. It is not unusual for any government to make technical amendments to legislation or regulations occasionally to address an unusual policy outcome. The government has no excuse in this situation. There is a very serious problem with how this audit program is being administered—and the Department of Human Services and the minister have even belatedly acknowledged those concerns. More sensible discretion needs to be applied to distinguish the very few practitioners who have committed fraud from those who have made minor and relatively inconsequential administrative errors. If the government believes it cannot, for whatever reason, ensure sensible discretion is applied, then appropriate changes should be made to the determination to at least provide a sensible outcome.

Another argument put by the government is that practitioners should have been aware of every detail in the legislation and regulations of the scheme. Indeed, Minister Plibersek said on 12 October 2011: 'We have written to every dentist in Australia telling them about the scheme and the requirements of the scheme.' However, the Department of Health and Ageing has stated that registration databases were not used to communicate with dentists but, rather, the databases of the Australian Dental Association, the Australian Dental Prosthetics Association and Medicare Australia were used. Therefore, by their own admission, not all practitioners received the information, let alone been made aware of the technical paperwork requirements. The ADA has advised that there would have been 13,000 registered practitioners at the time, but only 10,000 booklets were sent out. Further, the ADA advised that a survey of practitioners found that over 30 per cent had never received any information on the scheme and, even as late as 2010, 80 per cent were unaware of the administrative compliance requirements and penalties.

It is estimated that a dentist keeps only about 30 per cent of the Medicare benefit for providing a service. The remainder of the revenue pays for treatment and practice expenses. The demand for 100 per cent reimbursement of Medicare benefits for failure to send a form on time means that dentists have to repay money for treatment that has been provided and for which expenses have been incurred. The financial consequences of this action for those concerned are dire.

In the interests of commonsense and fairness, a solution needs to be found for the 80 per cent of practitioners audited who have acted in good faith but been found non-compliant. This bill provides a reasonable and measured response. It requires the minister to take action to redress the inequity that has arisen, and which could arise, from the operation of section 10, subsection 2 of the determination. The minister must take action within 30 days of the commencement of the act.

The inequity defined in the bill is the requirement for the practitioner to repay Medicare benefits because they did not, before providing the services, give patients, in writing, plans of courses of treatment; give patients quotations for dental services; and give copies or written summaries of the plans to the general practitioners who referred the patients.

The bill requires the minister to take one or more of the following actions: amend the determination; provide for the Commonwealth to waive its right to payments of debts arising under section 129AC of the Health Insurance Act 1973 in relation to dental services; provide for act-of-grace payments to be made in relation to the dental services; provide for the inequity to be redressed through the income tax system; and take such other action as is necessary to redress the inequity.

Schedule 1 of the bill provides for amendments to the determination as an option for the minister to provide redress. Specifically, the proposed amendment states that subsection 2 does not apply in relation to a dental service if, at the time the service was provided, the practitioner did not know about that subsection, or did not fully understand or appreciate the effect of that subsection or was under a reasonable misapprehension about the need to comply with that subsection. The amendment is to apply to a dental services provided before the commencement of the schedule and for which a Medicare benefit was not payable because of the operation of section 10.

The bill also requires the minister to prepare a report of the action that has been taken to redress the inequity that has arisen, and which could arise, from the operation of section 10 and cause a copy of the report to be tabled in each house of the parliament.

Labor ministers have long made clear their intention to close the Medicare scheme. The policy justifications have been flimsy at best. No attempt has been made to refine the scheme and address issues as a government funded initiative would normally require. Government rhetoric has been instead focused on sabotaging and undermining a successful program that was initiated by Tony Abbott as health minister. The government is more concerned about the politics of dental care than good policy.

The government has even dumped its own planned replacement for the scheme. In 2008, Labor proposed the Commonwealth Dental Health Program. The program promised one million services by providing funding to the states and territories. The Commonwealth did not assess the capacity of the public dental workforce to provide the services. In reality, the number of services provided would have been significantly less than that promised. Irrespective, it would not have come close to matching the 12 million services that have been provided under the Medicare scheme.

Labor never delivered its much promised Commonwealth Dental Health Program and it was finally scrapped in this year's budget. Despite the government's rhetoric about dental health, there was only about $60 million in net new funding out of the $500 million announced in this budget—it was simply made up of a re-announcement of existing measures. More promises have again been made but it remains to be seen whether anything will be delivered.

Any government funded dental scheme is going to require the participation and cooperation of the dental professions. The government is in the process of destroying the trust of those professionals. Dr Johnson, a particularly brave doctor from Tasmania who has to pay back $24,000, which is three times more than she received as an employee in a dental practice, spoke for many in the profession when she said, 'There is now no chance of getting a public dental scheme off the ground because dentists as a whole will no longer trust the government.'

This bill should not be required. No government and no minister should have let good intentioned health professionals be treated in this way. The bill requires the minister to redress this intolerable situation and provides a range of sensible options for doing so. Any member of parliament who genuinely supports fairness and common sense in administrative processes, who wants to ensure patients continue to have access to timely dental health care and who recognises the importance of the dental health professions in meeting this growing area of health need, must support this bill.

In closing I want to appeal in particular to the Independents. I think they are people of good intent, particularly those who have had a great injustice delivered upon them by this government. The Independents have dentists in their regions, and dentists across regional Australia have been affected, in particular, by the measures contained in the government's rather draconian approach to this problem.

As I have outlined today, for the majority of dentists the work has been completed to a high standard and to the patients' satisfaction. The issue for dentists in electorates right around the country, including those held by Independent members in this parliament, needs to be addressed and it is able to be addressed by this bill. This bill does not go over the top. It provides, as I say, a measured and reasonable approach. It provides a solution for the dentists to continue to practise, particularly in regional, rural and outer metropolitan areas. That is why I think the Independents should support the bill that has been proposed today.

Steve Georganas (Hindmarsh, Australian Labor Party) Share this | Link to this | Hansard source

Bills that deal with people's dental hygiene and dental health are extremely important to all of us. I have a seat, which is one of the oldest in the country, where well over 20 per cent of the population is 65 and over. The issue of dental health and dental care has been one very close to my heart for many, many years, as I know it is for the member for Shortland, who is in the chamber with us. From day one when I was elected, constituents would come to see me to tell me that they were concerned that there was no scheme in place, that there was very little in the way of dental healthcare and that they would have to go on the public waiting list.

Prior to 1996 the Keating government had put in place a Commonwealth scheme for dental care. One of the very first acts of the former Liberal government, when they came into government in 1996, was to cut that scheme, which put thousands and thousands of people on the public waiting list and extended that waiting list blow-out to, I think, about 700,000 people at one stage. We had many people, especially people who were pensioners, who were frail and who had bad health, on waiting lists for years and years with their teeth rotting, being in pain and deteriorating very quickly, which caused other issues and problems. I raised this issue many, many times whilst in opposition. All we were told was that it had nothing to do with the then government and to go and see the state government.

My view has always been that, when you break an arm, you go to hospital or to your doctor and you will be looked after. When you break a tooth, you could be in just as much pain and it could be just as detrimental to your health, yet no-one wants to know about it. So this is a very important issue.

For many years we have been talking about these particular issues. I know that the Australian government understands the importance of providing timely, affordable and high-quality oral healthcare to Australians. It has long been the Gillard government's policy to close the chronic disease dental scheme and to replace it with a new Commonwealth dental health program. This is because the chronic disease dental scheme, while providing the services for some parts of the population, is not well targeted and does not provide assistance to access dental services for Australians most in need. Many of those whom I spoke about earlier from 1996 onwards were people most in need. The government's proposal for the CDHP would provide additional public dental services for pensioners and for concession card holders.

However the Senate has twice prevented closure of the CDDS, which means that the government has been unable to implement this program and the scheme continues to operate. As I said, for years in opposition I would raise the issue of dental care, I would raise the issue of dental hygiene and all we got back was, 'It's got nothing to do with the federal government. Go to your state government and complain.' So it is quite ironic that the first time we hear anything about dental health is through this particular private member's bill, the Health Insurance (Dental Services) Bill 2012, where the opposition want to give a free pass to the dentists. What about all those mums and dads out there, battling with school fees, with the rising cost of living—those people in need? They go on about them receiving the family payments et cetera. We have an opposition that says they should pay back the funds to which they were not entitled, even under financial strain, under the family package payments that were announced last week. But here we have them saying that those people who have perhaps breached should pay back funds through their taxes. The majority of dentists are fine, upstanding people and we need them, but certainly investigations have taken place and we have seen that this particular area is an area that needs to be scrutinised. It is just like anyone else—when you are given that amount of money to go to the dentist to have your teeth fixed, they need to be done—and where investigations have been done, where there have been breaches they have been asked to pay back the money. So it is interesting to see today that the first time the opposition have come to this place to talk about dental services is when they are seeking to pay money back to dentists.

This is a big, big issue. It is a huge issue in terms of ensuring that we provide services for the public that require the services of dental healthcare. This government provided around $2.27 billion, which has been claimed under this particular scheme. It commenced in 2007. We have come up with another scheme which will ensure that those in need go off that list and that will ensure that they have their teeth and their dental hygiene looked after.

We have an opposition which, through this private member's bill, wishes to give a free pass to one section of our society which does not need a free pass, which does not need overpayment from the Commonwealth. That is what this is all about. They should be more able than your average age pensioner, or family or disabled pensioner to pay back where breaches have been found. There is over $21 million owed to the Commonwealth. Over $21 million of public funds have been received when they should not have been. It is pretty simple; it is not rocket science. Now the opposition says the government should not worry about that—let it go, just let it slide. That is a double standard and the double standard is shocking. It is almost unbelievable.

The Chronic Disease Dental Scheme is an animal of the conservative government of John Howard and here we are saying that we want to pay back money for breaches that are owed to the Commonwealth, which is taxpayers' money. This scheme was introduced into parliament and passed in the very last days of that government, with a view to giving the Australian public the impression that it was doing something about poor dental health in our community. As I said, for many years many members in the then Labor opposition raised this issue continuously only to be told not to worry about it and 'to go back and see your state government'.

While the rules have been in place for some four or so years the opposition says that they understand that dentists might not understand them. The rules are there for everyone and people should understand them. Not understanding the rules is not an excuse. They also say that they cannot be expected to know and apply the rules. Their argument is insulting to dentists and offensive to taxpayers all around the nation.

We all know that dental health is a central element of a person's health. We know that without good teeth or, more to the point, with really bad teeth, people do not eat as they need to and their health deteriorates. Nutrition is compromised and people become more exposed to contracting any number of ailments that affect members of our communities. We know it can affect cardiovascular health; it can affect a whole range of things. This is something that the public has known for many, many years. They also recognise that the states have not been up to the task of running and fully funding a dental scheme that meets community need.

As I said, there was a Commonwealth scheme, which was axed by the then Howard government as that government's very first act in government in 1996. After a decade of denial of Commonwealth responsibility by the former Liberal government, they finally buckled to community pressure and decreasing popularity and introduced their Chronic Disease Dental Scheme. The government has long held the view that the Chronic Disease Dental Scheme is a deeply flawed scheme. It is open to millionaires, as it is not means-tested. It is another example of conservatives' wastage of public funds through welfare for the top one per cent. In the meantime, over the Howard period we had 700,000 battlers on that waiting list. It does not ensure accountability. Dentists have been getting their public money even if they have not completed the work. Constituents have come to my office who have paid that money through the scheme and the work has not been completed or was not done properly. They go back and get told that the money has run out and that they should go to their doctor when the time is up and get another piece of paper to go back. You can see that these people have gone there in good faith with this scheme to have their dentures or their teeth fixed and you know there has been no accountability. Therefore, although one can say that dentists have been getting it wrong or do not know, there are criteria and people should follow those criteria, like any other organisation.

Broader than this, it is open to rorts. People are being treated without chronic conditions. The gesture within the scheme that it is targeted for the benefit of those with chronic conditions does not even stack up. We have had health professionals acting very unprofessionally with taxpayers' money without redress or penalty. This government's audit of the scheme has shown the scheme to be not working properly. And now the opposition want the government and the Australian taxpayer to wave off that manipulation that has been exposed. We have talked about $21 million. That is a lot of taxpayers' money.

The opposition wants us to adopt their position: if you are a pensioner, the government will get every cent that has been paid in error, but if you are a dentist, don't worry about it—keep the thousands of dollars delivered for each and every patient, because we're not worrying about it. But, if you are a pensioner and you have been paid one cent over the amount that has been on to you, we will pursue you. This is what the opposition are saying. It is a double standard and the hypocrisy is unbelievable. It is not good enough for anyone to take public funds inappropriately and then, when caught out, say as their excuse that they did not know the rules. That does not stack up anywhere.

I would like to ask the member opposite whether he ever had a constituent, an age pensioner, who had been told that they will need to pay back hundreds of dollars to Centrelink because of some error or something that they did not know, as the dentists are saying. The pensioner pleads for his help, saying they simply cannot afford it. Has the member ever been asked for help in such a situation, and what did he say there? What would the member have said to a pensioner who said that? 'We do have rules and we need to apply those rules.' But surely we must apply the rules fairly, impartially, without favouritism—not for one section of the community but the same across the board for everyone.

I appreciate that the opposition has at least acknowledged that the scheme is an issue, because we all know it is. It is an issue. It always has been. It does not meet the basic needs of our electorates—the people who need our care. I have had so many people in my electorate of Hindmarsh crying out for dental care, for a real dental scheme, since I became the member in 2004. I have had examples of people who have performed their own dental work because they could not afford to go to a dentist and because of the list was so long. There was a report in the media about a gentleman who drank a bottle of scotch and with a pair of pliers extracted his tooth—very painful, very graphic, but true. He actually did it because he was on a list that would have taken two years to have his painful tooth looked at.

These are real issues and we really need to ensure that people get the dental scheme that they require, because, as I said at the beginning of this speech, when you break an arm you go to your doctor or the hospital and they look at it and treat it. If you break a tooth, we need to have the same form of service as we do for all our health.

Ken Wyatt (Hasluck, Liberal Party) Share this | Link to this | Hansard source

I rise to speak in support of the Health Insurance (Dental Services) Bill 2012. I hold my colleague from Hindmarsh in high regard. However, I do not agree with the tenets of some of the points that he makes in terms of accountability. We have a profession that has been committed to improving the health outcomes of Australians. It does not matter where they work. I know many through various avenues and I know their commitment is extremely strong. If people take taxpayers' money and use it in a way that is not prescribed in legislation, regulation or criteria for that funding, then I have no problems with their having to repay it. But I have an issue when we make statements in this chamber that are global in context but are hypocritical in the sense of applied uniformity across various areas of government. That ranges from members of this parliament through to the pensioner that was referred to. Of course, we all see people who have issues with the way in which government services are provided and the way in which they are charged. But in this instance a profession has been brought into a model in which the administrative requirements are onerous insofar as the workload that they have in the provision of dental treatment. Sometimes it is easy, out of an audit, to take a sledgehammer approach instead of an approach that would consider each of the individual aspects that relate to a perceived rorting of a system.

The bill that is proposed by the shadow minister, the member for Dickson, is designed in the Gillard government's vindictive pursuit of dentists who have provided treatment to the neediest Australians under the Chronic Disease Dental Scheme. The bill requires the minister for health, in conjunction with such other ministers as may be necessary, to redress past and future inequalities that arise from the operation of subsection 10(2) of the Health Insurance (Dental Services) Determination 2007. How often do we hear, across the history of legislation, that we need to make technical amendments because, although the intention of a piece of legislation is honourable, the processes required for its administration has teething problems? During that period of teething problems, mistakes are made. I know from constituents who come into my office that there are often issues that arise because legislation has not been understood. They have been penalised, they have received a letter from a government agency and we have advocated, through the agency or through the relevant minister, for consideration to be given to those specific issues. Often they are addressed and they are often remedied, except those in circumstances where they have rorted and it is demonstrated that they have rorted. Eighty per cent of dentists have not deliberately rorted a system that is providing health care to those who are in need.

The member for Hindmarsh mentioned millionaires being recipients. I do not want to enter into a class war. This is about all Australians. This is about accessing services that can prevent the onset of chronic conditions because of poor dental health. Have a look inside the mouth of somebody who does not access a dentist and you will find the origins of chronic diseases that will cost much more to the health system in the longer term. In those circumstances the impact is far greater, and therefore I find it fascinating that we would pursue this end in terms of government action to claw back $21 million. What they should be doing is looking at each individual case. If there is rorting, then deal with those who rort. Where there is a genuine mistake because of an understanding—not a lack of understanding—of the processes, then we should give due diligence and consideration to ensure that we keep dentists engaged in the delivery of services to those who have the greatest need.

I often hear ministers in the main chamber talk about 'battling families' and how Labor is committed to providing services to those who have the greatest need. I have heard them say that millionaires should not receive funding for some of the programs. But I would hate to see a dental health service that has every intention of providing beneficial outcomes for the health of every Australian diminished because government is proposing to take a sledgehammer approach. I participated in the whole health reform. That was about no blame. That was about shifting the blame game and looking at practical approaches to the health needs of Australians where there is a continuous, seamless flow between each of the sectors in order for health to be provided.

The Health Insurance (Dental Services) Bill would seek an end to the injustice Labor appears determined to inflict upon the nation's dentists and dental professionals. The bill will require the minister to halt demands for repayment that Medicare is issuing to hundreds of dentists for a technical breach of the law.

Dentists are facing demands to repay all Medicare benefits they have received, despite having provided full courses of treatment. If I take the proposition by the member for Hindmarsh about rorting or that a misunderstanding or a lack of knowledge should be applied in this instance, then let me share with you something that I listened to with great interest on a radio station in Western Australia. Under the BER program, where subcontractors to builders were not receiving their payments, they discovered when they approached the Commonwealth department responsible was that the companies had submitted affidavits saying that they had paid their subcontractors when in fact they had not. Let me also say that those agencies are not prepared to follow through with those breaches that are deliberative and are not prepared to tackle an issue that is absolutely wrong and has a stench to it. Yet, with dentists, we are prepared to make sure that they repay for services provided.

If we damage this scheme and damage the capacity for people to access services that will make a difference to their health, then oral and dental infections will increase. People's capacity to access dental services will be problematic. If I were one of those dentists affected, I would be less likely to want to play ball and be part of a Commonwealth program, not trusting a government, because 85 per cent of dental services are rendered by private dentists who service about 12 million Australians annually. Seven million of the other 10 million are eligible for public dental care, but what is received is approximately 1.5 million occasions of service annually. We should not diminish the need. We should really out of an audit and, having been involved with audits, what you do is you go to the crux of the problem and look at the issues. Do not apply a uniform approach that damages.

If this government is serious about meeting the needs of the battlers, then do not punish if there are mistakes that are genuine. Work with the individuals, remedy the problem, ensure the continuity of dental care that reduces the long-term impact on the health of individuals.

I certainly hope that the minister will redress what is required and make the technical amendments so that we can have a strong and vibrant program that enables ordinary families, ordinary Australians, to access the health care that they need through their dentists and in concert with their GPs; and that the care plans required are a step that, if that is problematic, then it is remedied. They are given the encouragement and support to ensure that that occurs.

I support the proposed bill and hope that government considers the impact of any decision which will be detrimental to all of those who are in need of dental health treatment; that the approach that they are taking will be reconsidered; and that each dentists is considered on a case-by-case basis so that we have a strong, viable program that is provided and accorded to all of those who have a need.

Geoff Lyons (Bass, Australian Labor Party) Share this | Link to this | Hansard source

I rise today to speak on this legislation introduced by the member for Dickson in March this year, the Health Insurance (Dental Services) Bill 2012. A lack of universal access to high-quality dental health services has a significant impact on the health outcomes of Australians. As seen in our recent budget, delivering more affordable oral health and improving access to dental services for Australians is a major priority of the Gillard Labor government. We have much work to do to improve dental services. A prime example of this is the Chronic Disease Dental Scheme, where people are able to get high level crowns and bridges and cosmetic work, whilst there are children in rural and remote communities who cannot see a dentist when they have rotting teeth. We need a targeted dental system that sees money go to where it is needed.

The Chronic Disease Dental Scheme was established by the member for Warringah at the 11th hour, before the 2007 election, when he was health minister. It was a lemon. Since the inception of the scheme, $19.97 million has been identified as being incorrectly claimed from Medicare by dentists. The Chronic Disease Dental Scheme was designed to allow patients with a chronic condition to access up to $4,250 worth of dental services as part of their treatment for that chronic condition. Patients are referred to a dentist by their treating GP. There has been much criticism of this program since its inception. Much of it has revolved around the use of the term 'chronic condition'.

There have been a number of recent media reports about dentists who are being required to repay incorrectly claimed benefits. Like all health practitioners claiming Medicare benefits, dentists must fulfil all of the requirements when making a claim. This is no different from anyone seeking to claim public money for any cause. The government has a responsibility to ensure taxpayer dollars are spent appropriately. We make no apologies for this. Dentists have been provided with regular information about what they need to do in order to make a claim.

Whilst the government believes that that CDDS was poorly designed, the rules governing the scheme have been publicised to dentists many times by both the government and the Australian Dental Association. This communication includes several direct letters, journal articles, fact sheets, a booklet, a phone inquiry line, website information and a compliance checklist.

A number of steps were taken to ensure that dentists had the opportunity to understand their legal obligations prior to submitting claims for Commonwealth benefits. In September 2007, prior to the commencement of the scheme, the then health minister, the Hon. Tony Abbott MP, wrote to all practitioners and outlined the scheme's requirements. I am also advised that, upon commencement of the scheme in November 2007, the Department of Health and Ageing wrote to all dental practitioners, dental specialists and dental prosthetists describing the scheme and its requirements. The Department of Health and Ageing also issued a fact sheet, as well as the Medicare Benefits Schedule Dental Services Book, which specifically outlined the requirements of the scheme and the related eligibility criteria.

May I also note that included in this reference material was a referral to a Medicare Helpline and a checklist designed to further assist dental practitioners in complying with the requirements of the scheme. The checklist appears in the same booklet that dentists would refer to to check Medicare item numbers for claiming purposes. There should be no grey area with regards to what a dentist could claim. Medicare has an obligation to ensure compliance with the legislative requirements of the scheme and to ensure the taxpayer funds are paid out in accordance with the law. This is reasonable and it is what the Australian people rightly expect. The audits undertaken by Medicare are not random in nature. Practitioners are selected for audit as a result of complaint or tip-offs received from members of the public and/or where high claiming patterns raise concerns. Currently, less than 100 audits have been closed with fewer than 50 dental practitioners required to repay incorrectly claimed benefits.

In order to make a claim, dentists are required to inform patients and the referring GP about the course of treatment the patient will receive and make sure the patients understand the full costs of the treatment they receive. These aspects have never been voluntary. They are set out in Health Insurance (Dental Services) Determination Bill 2007

Medicare has provided dentists and the Australian Dental Association with regular information about their obligations on dozens of occasions. We know that Medicare conducts audits in a fair and professional manner, giving dental practitioners time to respond to audit requests and present information while still providing ongoing care to patients. Yet many dentists claim to be confused.

It has long been the Gillard government's policy to close the Chronic Disease Dental Scheme. While the CDDS provides services for some parts of the population, is not well targeted to provide assistance to access dental services to those Australians most in financial need. We have been clear on this. However, the Senate has twice prevented the closure of the CDDS, which means the government has been unable to put in place a more appropriate scheme.

Since 2007 the government has made a range of other important investments in dental health, including the establishment of the Medicare Teen Dental Plan, which provides up to $163.05 per person towards an annual preventative dental check. Since its introduction, this program has provided over 1.5 million checks for eligible teenagers, $11 million for Indigenous dental services in rural and regional areas and $52.6 million over four years in the 2011-12 budget to establish a voluntary dental internship program to help boost the dental health workforce. These welcome moves were warmly received.

The $515 million investment in dental health announced during the recent budget will lay the foundation for a new way of providing dental services, ensuring those most in need will receive care when and where they need it. The government is making a targeted investment of $515.3 million over four years in oral health for Australians who are least able to afford dental care. The new spending will see a blitz on public dental waiting lists, oral health promotion, a boost to the dental workforce and improved dental facilities in rural and remote areas. This package includes the important foundational work needed to make significant improvements to the dental system and represents a major step towards a new national dental scheme.

The 2012-13 budget included funding of $345.9 million for a public dental waiting list blitz, which would, according to the National Dental Advisory Council, address the current 400,000 people on waiting lists around the country; $10.5 million for oral health promotion and to develop a national oral health promotion plan to promote dental services and better oral health; $35.7 million for an expansion of the Voluntary Dental Graduate Year Program to offer 100 places per annum from 2016 to increase the dental workforce to deliver more dental services through a national scheme; $45.2 million for a graduate year program for oral health therapists to support 50 placements per annum; $77.7 million for rural and remote infrastructure and relocation grants for dentists to provide up to 100 infrastructure grants and up to 100 relocation grants to support up to 300 dentists in setting up practices in rural areas to meet the current shortage of dental services in rural and remote areas; and $450,000 to non-government organisations to coordinate further pro bono work by dentists.

Anyone claiming funds from the Australian taxpayer has an obligation to do so in accordance to the law. Dentists are no exception. Quite simply, the government does not support this bill. It is the government's intention to close the CDDS and put in place more appropriate policies. I therefore reject this bill.

Ewen Jones (Herbert, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the updated Health Insurance (Dental Services) Bill 2012 and support the many hardworking dentists who give of their time and energy to help others who cannot afford private health insurance. The shadow minister for health and member for Dickson is 100 per cent correct when he says this is an extreme reaction to what is primarily a clerical error. Let us all be straight here. If there has been fraud, if the work has not been done but the dentist has claimed for services he or she has not provided, then sue them into bankruptcy. To do something like that is beyond criminal, because they would be gorging on the carcass of the people who are most vulnerable.

But where a dentist has simply not completed a form, it should be clear to all of us here that when someone has been referred to a dentist by their GP they must be in the most dire dental straits. When confronted with someone coming to them who has severe health issues relating to rotting teeth, any health professional will invariably act first. If they have not completed the forms properly, then let us get them completed and move on. What is the big game here? What are we trying to achieve? In suing some dentist into bankruptcy over paperwork tardiness are we more or less likely to see health professionals such as dentists tell the public system that they will take on public patients? Are we more or less likely to see our dental waiting lists reduced? I contend that most health professionals, when confronted with the severe consequences of noncompliance, would baulk at doing what is essentially the right thing.

The member for Bass was talking about the paperwork that has been going out to all the dentists—fact sheets and all those sorts of things. We drown small business in paperwork; we drown professionals in paperwork. To do these things and to claim back absolutely everything that has been done when the work has been done professionally and properly is just wrong in my thinking. What would be a better result for the patient? This bill requires the minister to do one or more of the following within 30 days of the act commencing: firstly, making an amendment to the determination in accordance with the amendment set in schedule 1 of the bill—the proposed amendment and schedule 1 provides exceptions to a10(2) of the determination where the practitioner did not know about the subsection, did not fully understand or appreciate the subsection or was under a reasonable apprehension about the need to comply with that subsection; secondly, waiving the right to repayment of the Medicare benefits; thirdly, making act of grace payments; fourthly, providing for the inequity to be addressed through the income tax system; and, fifthly, taking such other action as is necessary to redress the inequity.

The minister must prepare a report of action that has been taken and table it in each of the houses of parliament within 15 sitting days. Of the 89 completed audits, 63 dentists have been found to be non-compliant. Of these 63, 51 have been found to have completed the work. In fact, many dentists have gone above and beyond what was approved by Medicare and done extra work at no cost to the patient or the taxpayer. This is because, like the great majority of health professionals in Australia, they want to do the right thing. Medicare has said it has shown leniency, but only 17 of the 63, roughly one-quarter, have incurred only 'education action' with no cost recovery.

There are strong links between poor oral health and poor systemic health. If you have a bad run with your teeth, you will end up being sick. We need to be doing more to get successful, professional dentists to avail themselves to assist with the backlog of public dental work, but we need it to be on a productivity basis. We cannot make it so hard for professionals that they virtually throw their hands up in the air and walk away and charge privately and make more money for themselves. Charge and convict the rorters of the system, but, when the work and more has been done, do not do not hang dentists because the paperwork is not done to our liking. Work with them and get the necessary crosschecks done and then get out of their way. They have patients waiting.

I see dentists all the time who give of their time. In Townsville we have a bloke by the name of Daryl Holmes, who volunteers his time for three weeks of the year. He goes up to the Torres Strait and works in the Southern Highlands of Papua New Guinea performing up to 80 extractions per day.

An honourable member interjecting—

You do not know if he has made a mistake, but he is giving of his time, he is volunteering of his time, and those are the things that we are going to have to watch out for—that we make it so hard for people that they simply do not make themselves available for the system. (Time expired)

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

I must say that I find it really interesting that the first piece of private members' legislation the shadow health minister tries to introduce is legislation to protect dentists. It is not about good, strong health policy and it is not about increasing health services. I find that unbelievable and a double standard. I have heard previous speakers in this debate say, 'These are professional people; they need to be protected; they're too busy; they shouldn't have to worry about this paperwork.' It is unbelievable.

I had a constituent come to see me who was hospitalised and she filled out her Centrelink forms incorrectly. What happened to that Centrelink recipient? She ended up before the court because they said she had defrauded the government. It was a very sad case. She managed to not have a conviction recorded against her, but she was held accountable to the nth degree. Yet we have members in this House standing here arguing that dentists should not be held accountable if they do not fill in their paperwork correctly. That is all this woman did: she filled in her paperwork incorrectly. I find it absolutely unacceptable that there should be one standard applied to dentists and another standard applied to every other person in the community. I think the shadow minister for health should really turn his mind towards developing some good, sound health policy.

The chronic dental health program is a program that has been fraught with problems. As has been said by previous speakers on this side of the parliament, this is a program that we would like to end and which we have been trying to bring to cessation, but we have been stopped by the opposition. It is a program that benefits a very small group of people and it is a program that is really hard for a lot of people to access. I experienced that with my own mother, who was extremely ill but could not access the program because of the complicated nature of application and the fact that her doctor did not think it was a good program—that it did not work very well.

We on this side of the parliament believe that delivering health and dental services is about delivering those services; it is not about propping up dentists and it is not about selecting one group of people to be eligible to access a program. It should be about a person's need. Some people who have accessed the dental health program are millionaires, whereas people that are on a pension have not been able to get the dental health treatment they need. They are on lengthy waiting lists. The state government has not funded their side of the scheme properly and that is from both persuasions. I am not just saying it is a Liberal Party problem; it has been both sides of the equation. When the now Leader of the Opposition was health minister, before this program was introduced, he used to argue that the Commonwealth supports dental health through private health insurance. Well, the most needy people in the community—those people who really need to access a Commonwealth funded dental health program—cannot afford health services.

This only refers to 37 dentists nationwide, so it shows that most dentists can fill out the paperwork and comply. To think that the shadow minister for health can come in here and introduce legislation that is going to benefit 37 dentists retrospectively but not come in here to introduce legislation to provide dental health care for the most needy people in our community is absolutely despicable. I think he stands condemned by the legislation we have before us today.

Natasha Griggs (Solomon, Country Liberal Party) Share this | Link to this | Hansard source

I rise to support the motion put forward by the member for Dickson. The Chronic Disease Dental Scheme was put in place to provide dental treatment to the most needy of Australians. The coalition has introduced the Health Insurance (Dental Services) Bill to end the Gillard government's malicious pursuit of dentists who, for the most part, have been trying to do the right thing. It is indeed unfortunate that this situation has come to this. When Tony Abbott as health minister introduced the Chronic Disease Dental Scheme, a $1 billion investment was put into dental services in this country. The scheme provided for general practitioners to refer patients with a chronic disease or complex health problem to a dentist for treatment. This scheme provided treatment up to the value of $4,250 over any two years.

That Rudd and Gillard governments have tried in the past to close down Tony's scheme but these moves were rejected in the parliament. The Gillard Labor government has tried to label the scheme as rorted and corrupt, but the evidence of these allegations is as much in existence as their integrity. As with any government scheme, there are people who will attempt to rort it. I want to make it clear that if any health practitioner did rort the scheme they should be singled out and dealt with accordingly. However, in this situation, we have before us a collective of community minded, good, honest dental health practitioners who provided dental services under the Chronic Disease Dental Scheme. I am talking about dentists who have treated their patients and have done the right thing by them. These dentists claimed the appropriate Medicare benefits to which they were entitled. Yet now, due to a technical failure to provide their patients with a written treatment plan, or a failure to forward the treatment plan to the general practitioner who had referred patients to them in the first place, they find themselves being pursued by Medicare demanding repayment.

These dental professionals did what we needed our dental professionals to do, and that was to treat the patients who had complex health problems and chronic diseases. There were technical breaches of the law, but when you take into consideration the good intent of the dental practitioners and the manner of the breaches, a fair-minded person would be accommodating an understanding—but not this government, who are instructing Medicare to pursue the dentists.

The important point in this policy is to remember that the bulk of dental professionals who have fallen foul of the requirements of the Chronic Disease Dental Scheme were actually doing so because they were failing to fill in the paperwork. They were not rorting the system; they still did the job. Many dentists around the country have stated that they were not fully briefed on the requirements that they were to undertake. The Australian Dental Prosthetists Association was never, ever approached regarding the Chronic Disease Dental Scheme. Adding to this, 990 of the nation's 1,100 dental prosthetists participated in the Chronic Disease Dental Scheme. How were they expected to be aware of the paperwork commitments if they were not engaged?

On a positive note, though, 11,713 dentists provided treatment under the Chronic Disease Dental Scheme. They have provided more than 11 million treatments to one million Australians. Last year alone in the Northern Territory there were 5,771 category 9 dental services undertaken and 1,256 category 10 dental benefits scheme services.

In all the Northern Territory and all around the country there is a rural dental workforce shortage. This is an occupation we need to develop and grow. We must not let this blight deter future dental practitioners. The problem has been caused by the Labor government's mismanagement. I support this bill because it will sort out the problem and help dental practitioners who do the right thing.

I urge the minister to make the technical amendments that will ensure that everyday Australians have access to the healthcare they need. We need to ensure that we have a strong, viable program. Do not punish those who are doing the right thing. Deal with those who are rorting the system. I reiterate: we need a strong, viable program that will give ordinary Australians access to the health care they need.

Deborah O'Neill (Robertson, Australian Labor Party) Share this | Link to this | Hansard source

I am pleased to speak to this matter after the member for Solomon, who articulated this program by the name of 'Tony's scheme'. I understand that 'Tony's scheme' was actually introduced by a letter from the then minister for health letting the profession know exactly what the requirements were. Indeed, I understand that there have been some 40 communications to people who are usually highly educated to engage in the profession of being a dentist, people who have to fill out BAS forms, small businesspeople who have to read information from the government in all its forms. This small group of people who have rorted the system are now saying, 'Look, I am sorry, I did not read the letter correctly.'

Just this weekend I was reminded of a fantastic young man in my electorate who is on a disability pension. He religiously seeks out work and every time he goes to report correctly how much work he has done to make sure that he gets correct payment and no more assistance than he deserves. He takes great pride in following the requirements, taking advantage of the offer of support from the government but not exploiting it.

What we have here is a group of people who have not only found out everything about the paperwork that suits their business model and selectively ignored any elements of the paperwork that provide care and protection to the public. We have got people who have set up a business model, who have gone into dementia units and have not had a treatment plan drawn up with an allied health professional or a GP, people who have gone in and trawled dementia units, gone ahead and done work on people without their permission, and left behind them a trail of smiles and unnecessarily expensive dental work done at the cost of all Australians who do need good dental care. This unhealthy and exploitative business model cannot be overlooked, and simply saying, 'I forgot to do that bit of the paperwork,' is an inexcusable comment by people from the profession, who should be ashamed to be standing up making these claims, let alone thinking that they have a case to be given the benefit of the doubt that they did not understand.

'Tony's scheme', as it was articulated by the member for Solomon, is in fact an opportunity for people who wanted to exploit the system to go ahead and do that. That is why this government, in making sure we are looking after benefits to Australians, is determined to provide a much healthier model of response to people who need to get access to basic things like fillings—and people would be quite happy with an amalgam one instead of a porcelain one to solve their dental issues. The reality is that in our budget we have committed to absolutely crunching down on those public health waiting lists to make sure that people are able to get the support they need and get access to basic health when they need it.

When this system was set up, Medicare made it very, very clear that there were two essential elements of any organisation of a treatment plan. There was a quote to be provided to the person who was seeking assistance, and a treatment plan to be communicated to the GP. These are not onerous requirements. In fact if you were to go to any dental professional that is the kind of thing that you would generally expect. The fact that dentists were taking this money from the federal government should have alerted them even more so, in addition to normal standard professional practice, that they were required to keep adequate records. It just does not wash that people who have been brought to our attention because of excessive servicing, people who have been brought to the attention of the authorities because of complaints about the quality of their professionalism and the quality of the work that they are doing, are being supported by those in the opposition saying that they should get money back.

The reality is that this scheme was always a problem. Tony's scheme, as the member for Solomon described it, was a problem waiting to happen. He did not provide adequate information for people early on—that is what they are claiming. That absolutely causes a problem for those people within the profession and it needs to be completely removed to allow us to get on fixing up a proper dental scheme.

Kelvin Thomson (Wills, Australian Labor Party) Share this | Link to this | Hansard source

Order! The time allotted for this debate has expired. The debate is adjourned and the resumption of the debate will be made an order of the day for the next sitting.